Management of pulmonary embolism: recent evidence and the new European guidelines

Venous thromboembolism (VTE), which encompasses deep vein thrombosis and its most dangerous complication, acute pulmonary embolism (PE), represents a major threat for the health, the well-being and, under certain circumstances, the life of a large number of patients worldwide. With its acute and long-term complications, VTE also poses a substantial economic burden on national health systems. Alarmingly, since the risk of VTE approximately doubles with each decade after 40 years of age, it is to be expected that an ever larger number of individuals in “industrialised”, ageing societies will be diagnosed with the disease in the years to come. In 2014, the results of landmark clinical trials and cohort studies, particularly those published in the preceding 6 years, were included in the update of the European Society of Cardiology (ESC) guidelines on the management of PE [1]. In the 2014 ESC guidelines, which were endorsed by the European Respiratory Society (ERS), several recommendations regarding diagnostic strategies and algorithms were retained and their validity reinforced and extended. In parallel, new data extending our knowledge with regards to optimal risk assessment and risk-adapted patient treatment led to major revisions in the recommendations in these latter areas, and new sections on the long-term sequelae of PE as well as its management in specific patient populations were added. The present article summarises and highlights the most relevant new aspects of the 2014 version as compared with the previous European guidelines published in 2008.