title: Management of Pulmonary Embolism: An Update.
abstract: Pulmonary embolism (PE) remains a major contributor to global disease burden. Risk-adapted treatment and follow-up contributes to a favorable outcome. Age-adjusted cutoff levels increase D-dimer specificity and may decrease overuse of imaging procedures and overdiagnosis of PE. Primary systemic fibrinolysis has an unfavorable risk-benefit ratio in intermediate-risk PE; catheter-directed techniques are an option for patients with hemodynamic decompensation and high bleeding risk. New oral anticoagulant agents are effective and safe alternatives to standard anticoagulation regimens. Recent trial data do not support insertion of cava filters in patients who can receive anticoagulant treatments. Remaining areas of uncertainty include the therapeutic implications of subsegmental PE, the optimal diagnostic approach to the pregnant patient with suspected PE, and the efficacy and safety of new oral anticoagulant agents in patients with cancer. Campaigns to increase awareness combined with strategies to implement guideline recommendations will be crucial steps towards further optimizing management of acute PE.
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece. Electronic address: stavros.konstantinides@unimedizin-mainz.de.
authors.forename: Stavros V
authors.initials: SV
authors.lastname: Konstantinides
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Stefano
authors.initials: S
authors.lastname: Barco
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Lankeit
authors.affiliation: Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, and GIRC Thrombose, Paris, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D003952:Diagnostic Imaging / Q000379:methods*; D019468:Disease Management; D014943:Global Health; D006801:Humans; D009017:Morbidity / Q000639:trends; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D000925:Anticoagulants
keywords: anticoagulation; cava filters; prognosis; reperfusion; risk assessment; venous thromboembolism