Abstract
Swedish Healthcare is organised by relatively independent counties which are responsible for the appropriateness of delivered care. As a consequence, few formal guidelines are issued by national authorities or professional societies, which is the case for the treatment of pulmonary embolism (PE). The yearly incidence of PE in Swedish adults was 86/100,000 in 2011, corresponding to approximately 6000 cases with an overall mortality of 6.5%. Acute massive PE with circulatory shock carries mortality up to 50% but its true incidence in Sweden is not known. First-line treatment is intravenous thrombolysis but non-pharmacological alternatives for cases where thrombolysis has no effect or is contraindicated have recently undergone technical development. This includes catheter fragmentation, surgical embolectomy and extracorporeal circulatory support, which may be used as a bridge to further treatment in very unstable patients. This article summarises the treatment options for acute massive PE and their rationale as seen from a Swedish perspective.
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