Current treatment of acute pulmonary embolism

Background Acute pulmonary embolism is associated with high mortality and morbidity. Objective This article provides an overview of current risk-adapted treatment of patients with pulmonary embolism. Material and methods The article is based on recommendations of national and international societies as well as the most recent scientific findings and studies. Results The treatment of patients with pulmonary embolism is based on the estimated individual risk during the acute phase and ranges from outpatient treatment to reperfusion treatment. The individual risk for complications associated with pulmonary embolism and death increases with the number of concomitant diseases and the extent of right ventricular (RV) dysfunction. Treatment decisions for hemodynamically unstable pulmonary embolism patients should be made by interdisciplinary pulmonary embolism response teams (PERT). All patients require therapeutic anticoagulation for at least 3 months. Due to the comparable efficacy with a better safety profile compared to vitamin K antagonists, non-vitamin K-dependent oral anticoagulants (NOACs) are nowadays considered the treatment of choice. Conclusion Optimized strategies for risk stratification enable a differentiated assessment of the individual risk. Based on the results of the HoT-PE study, outpatient treatment of selected low-risk patients without RV dysfunction appears to be safe. Novel treatment options (interventional approaches as well as NOACs for therapeutic anticoagulation) contribute to a reduction of the bleeding risk.