Treatment of Pulmonary Embolism

Risk Stratification

The European Society of Cardiology recommends that pulmonary embolism (PE) should be stratified based on hemodynamic stability to guide treatment decisions 1, 3
High-risk PE presents with shock or hypotension, according to the European Heart Journal 4
Intermediate-risk PE is characterized by hemodynamic stability with right ventricular dysfunction, as stated in the European Heart Journal 4
Low-risk PE is defined as hemodynamically stable without right ventricular dysfunction, as noted in the European Heart Journal, although the specific citation is from Praxis Medical Insights, a more relevant citation is not available 3

The European Heart Journal recommends initiating unfractionated heparin (UFH) immediately with a weight-adjusted bolus followed by continuous infusion for high-risk PE patients 1, 4
Systemic thrombolytic therapy should be administered unless contraindicated for high-risk PE patients, according to the European Heart Journal 1, 4
Oxygen should be provided to correct hypoxemia in high-risk PE patients, as recommended by the Thorax journal and the European Heart Journal 5, 3
Vasopressors, such as norepinephrine and/or dobutamine, should be used to correct hypotension in high-risk PE patients, as stated in the European Heart Journal 1, 2

The European Heart Journal recommends using UFH with an initial bolus of 80 U/kg or 5,000-10,000 units, followed by a continuous infusion of 18 U/kg/h, adjusted to maintain aPTT 1.5-2.5 times control for high-risk PE or severe renal impairment 5, 7
Low molecular weight heparin (LMWH) or fondaparinux is preferred over UFH for initial parenteral anticoagulation in intermediate or low-risk PE patients, according to the European Heart Journal 1, 2

The European Heart Journal recommends considering inferior vena cava (IVC) filters in patients with absolute contraindications to anticoagulation or PE recurrence despite therapeutic anticoagulation 1, 2
Early discharge and home treatment should be considered for carefully selected low-risk PE patients, ensuring proper outpatient care and anticoagulant treatment can be provided, as stated in the European Heart Journal 1, 2
Non-vitamin K antagonist oral anticoagulants (NOACs) are not recommended in patients with severe renal impairment, pregnancy and lactation, or antiphospholipid antibody syndrome, according to the European Heart Journal 1, 2