Comment on the 2014-ESC Guidelines of Management of acute pulmonary embolism [Kommentar zur 2014-ESC-Leitlinie zum Management der akuten Lungenembolie]

Acute pulmonary embolism (PE) represents a major threat to the health and, occasionally, the life of a large number of patients in Europe and worldwide. Recently published landmark trials, which have led to significant progress in the management of the disease, provided the basis for the recommendations included in the 2014 update of the European Society of Cardiology (ESC) Guidelines. While diagnostic algorithms for patients with suspected high-risk and not-high-risk PE remained largely unchanged compared to the 2008 Guidelines, simplified versions of clinical prediction rules, as well as the use of age-adjusted D-dimer cut-off levels were introduced. Advanced risk stratification of patients without shock or hypotension was extended to include clinical severity assessment in addition to markers of right ventricular function and injury. In PE treatment, the results of recently completed randomized trials on new oral anticoagulants led to the recommendation of these drugs as an effective and safe alternative to standard anticoagulation regimens including heparin and vitamin K antagonists. For intermediate-high-risk PE, the bleeding risks of full-dose systemic thrombolytic treatment are considered to be too high to justify its use, unless clinical signs of haemodynamic decompensation appear. Finally, the 2014 ESC Guidelines include formal recommendations for chronic thromboembolic pulmonary hypertension, as well as for the management of PE in specific patient populations, namely during pregnancy and in patients with cancer. © 2015, Springer-Verlag Berlin Heidelberg.