Progress in the management of acute pulmonary embolism.

Abstract

Pulmonary embolism is a major contributor to global disease burden worldwide. The 2014 guidelines of the European Society of Cardiology, endorsed by the European Respiratory Society, emphasize the need for initial and advanced risk stratification as well as risk-adapted treatment to ensure the highest quality of care. This review summarizes the progress in pulmonary embolism diagnosis, risk assessment, and treatment. Major advances of the past 12 months include age-related biomarker cutoff levels for optimising pulmonary embolism diagnosis and risk stratification; detection of (isolated) subsegmental pulmonary embolism by computed tomographic pulmonary angiography, raising the question of appropriate treatment in these cases; benefits versus risks of systemic thrombolytic therapy in normotensive patients at intermediate-high risk of an adverse early outcome; catheter-directed reperfusion with low-dose thrombolytics for patients at high bleeding risk; lack of efficacy of retrievable vena cava filters in the prevention of pulmonary embolism recurrence; and specific antidotes for nonvitamin K-dependent oral anticoagulants. Recent advances in the diagnosis, risk stratification, and treatment of acute pulmonary embolism now permit, for the first time, the implementation of an integrated risk-adapted approach to the disease such as recommended by the recent European guidelines.