ESC Guidelines Updated for Diagnosis, Treatment of PE

In guidelines developed by the European Society of Cardiology, in collaboration with the European Respiratory Society, updated recommendations are presented for the management of patients with acute pulmonary embolism (PE). The guidelines were published online in the European Heart Journal.

Stavros V. Konstantinides, M.D., Ph.D., from Johannes Gutenberg University Mainz in Germany, and colleagues updated guidelines to address the optimal diagnosis, assessment, and treatment of suspected or confirmed PE.

The authors note that D-dimer cutoff values adjusted for age or clinical probability can be used as an alternative to the fixed cutoff value for PE diagnosis. Assessment of PE severity and early PE-related risk is recommended in addition to comorbidity and overall death risk in risk assessment. In patients who are considered low risk based on clinical risk scores, right ventricular dysfunction may be present. For acute treatment, hemodynamic and respiratory support has been revised for high-risk PE, and a dedicated management algorithm is proposed. In eligible patients, nonvitamin K antagonist oral anticoagulants are recommended as the first choice for anticoagulation. After the first three months, chronic treatment should take into consideration risk factors for recurrence; indications for extended anticoagulation are addressed. A dedicated diagnostic algorithm is proposed for suspected PE in pregnancy.

"The aim is to get to the diagnosis as reliably and quickly as possible, in order to start lifesaving therapy and prevent other clots from reaching the lungs," a coauthor said in a statement.

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