Diagnostics and treatment of acute pulmonary embolism Summary of the current 2019 guidelines of the European Society of Cardiology

A revised risk-adjusted algorithm for management of pulmonary embolism (PE) is proposed, which includes clinical severity, comorbidities and right ventricular dysfunction. Cut-off levels for D-dimer tests should be adjusted for age and clinical probability rather than using fixed values. Direct oral anticoagulants (DOAC) are now recommended as first choice anticoagulants over vitamin K antagonists. Although early discharge and outpatient treatment are possible for low-risk patients, in high-risk patients the airway should be reopened. Rescue intravenous thrombolysis is now a class I recommendation (previously class IIa) and interventional or surgical thrombectomy is now a class IIa (previously class IIb) recommendation. Interdisciplinary pulmonary embolism response teams (PERT) should achieve an improved care of high-risk PE patients. A dedicated diagnostic algorithm is proposed for suspected PE in pregnancy.