Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Sep 17;118(37):618-628.
doi: 10.3238/arztebl.m2021.0226. Epub 2021 Sep 17.

Acute Pulmonary Embolism–Its Diagnosis and Treatment From a Multidisciplinary Viewpoint

Hannah C Kulka  1 , Andreas Zeller, Jürgen Fornaro, Walter A Wuillemin, Stavros Konstantinides, Michael Christ
Affiliations
Review

Acute Pulmonary Embolism–Its Diagnosis and Treatment From a Multidisciplinary Viewpoint

Hannah C Kulka et al. Dtsch Arztebl Int. .

Abstract

Background: Physicians from many different specialties see patients suffering from acute pulmonary embolism (PE), which has an incidence of 39-115 cases per 100 000 persons per year. Because PE can be life-threatening, a rapid, targeted response is essential.

Methods: This review is based on pertinent publications retrieved by a selective literature search of international databases, with particular attention to current guidelines and expert opinions.

Results: Whenever PE is suspected, clinical assessment tools must be applied for risk stratification and diagnostic evaluation. The PERC (Pulmonary Embolism Rule-out Criteria) and the YEARS algorithm lead to more effective diagnosis. For hemodynamically unstable patients, bedside echocardiography is of high value and enables risk stratification. New oral anticoagulants have fewer hemorrhagic complications than vitamin K antagonists and are not inferior to them with respect to the risk of recurrent PE (hazard ratio 0.84-1.09). The duration of anticoagulation is set according to the risk of recurrence. Systemic thrombolysis is recommended for patients with a high-risk PE, in whom it significantly reduces mortality (odds ratio 0.53, number needed to treat 59). Surgical or interventional techniques can be considered if thrombolysis is contraindicated or unsuccessful.

Conclusion: Newly introduced diagnostic aids and algorithms simplify the diagnosis and treatment of acute PE while continuing to assure a high degree of patient safety.

PubMed Disclaimer

Figures

Figure
Figure
Treatment algorithm in the event of suspicion of PE (modified from [5, 29, 33]) ACS, Acute coronary syndrome; CTPA, computer tomography pulmonary angiography; LMWH, low-molecular-weight heparins; NOAC, new oral anticoagulants; PCP, primary care physician; PE, pulmonary embolism; RV, right ventricular; sPESI, simplified Pulmonary Embolism Severity Index; TTE, transthoracic echocardiography
eFigure 1
eFigure 1
Echocardiographic signs (transthoracic) of right cardiac overload AcT, Acceleration time; LA, left atrium; LV, left ventricle; RV, right ventricle; TRPG, tricuspid regurgitation peak gradient
eFigure 2
eFigure 2
YEARS algorithm for diagnosis of pulmonary embolism in pregnant women CTPA, CT pulmonary angiography; DVT, deep vein thrombosis; PE, pulmonary embolism
See this image and copyright information in PMC

References

    1. Agarwal S, Clark D, Sud K, Jaber WA, Cho L, Menon V. Gender disparities in outcomes and resource utilization for acute pulmonary embolism hospitalizations in the United States. Am J Cardiol. 2015;116:1270–1276. - PubMed
    1. Keller K, Hobohm L, Ebner M, et al. Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany. Eur Heart J. 2020;41:522–529. - PubMed
    1. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res. 2016;118:1340–1347. - PubMed
    1. Engbers MJ, van Hylckama Vlieg A, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost. 2010;8:2105–2112. - PubMed
    1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) Eur Heart J. 2020;41:543–603. - PubMed