title: Management dilemmas in acute pulmonary embolism.
abstract: BACKGROUND
  Physicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent.
  
  
  METHODS
  Fourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested.
  
  
  RESULTS
  Management dilemmas discussed include: sub-massive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants.
  
  
  CONCLUSIONS
  The suggested approaches are based on a review of the available evidence and guidelines and on our clinical experience. Management in an individual patient requires clinical assessment of risks and benefits and also depends on local availability of therapeutic interventions.
authors.affiliation: Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, , Sheffield, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Condliffe
authors.forename: Charlie A
authors.initials: CA
authors.lastname: Elliot
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Hughes
authors.forename: Judith
authors.initials: J
authors.lastname: Hurdman
authors.forename: Rhona M
authors.initials: RM
authors.lastname: Maclean
authors.forename: Ian
authors.initials: I
authors.lastname: Sabroe
authors.forename: Joost J
authors.initials: JJ
authors.lastname: van Veen
authors.forename: David G
authors.initials: DG
authors.lastname: Kiely
mesh_terms: D000208:Acute Disease; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine / Q000379:methods; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D018579:Patient Selection; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents