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Acute Pulmonary Embolism (Diagnosis and Management of) Guidelines

ESC Clinical Practice Guidelines

Pulmonary Embolism
Acute Cardiac Care
Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Pulmonary Hypertension
Venous Thromboembolism
Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Guidelines version available to download
Published in 2014
Reference Eur Heart J doi:10.1093/eurheartj/ehu283
Published in 2015
Reference doi.10.1093/eurheartj/ehu479
Published in 2015
Reference APE
Published in 2014
Reference Web Addenda
Published in 2014
Reference CME Questions - Acute Pulmonary Embolism
Published in 2014
Reference 2014 Take Home Messages & Gaps in Evidence
Published in 2014
Reference ESC Pocket Guidelines on Acute Pulmonary Embolism
Published in 2014
Reference Acute PE Mobile App with interactive tools
Published in 2014
Reference 40 Slides on Acute PE
Table of contents: Full Text (ESC Clinical Practice Guidelines)


  • Epidemiology
  • Predisposing factors
  • Natural history
  • Pathophysiology
  • Clinical classification of pulmonary embolism severity


  • Clinical presentation
  • Assessment of clinical probability
  • D-dimer testing
  • Computed tomographic pulmonary angiography
  • Lung scintigraphy
  • Pulmonary angiography
  • Magnetic resonance angiography
  • Echocardiography
  • Compression venous ultrasonography
  • Diagnostic strategies
    • Suspected pulmonary embolism with shock or hypotension
    • Suspected pulmonary embolism without shock or hypotension        

Prognostic assessment

  • Clinical parameters
  • Imaging of the right ventricle by echocardiography or computed tomographic angiography
  • Laboratory biomarkers
    • Markers of right ventricular dysfunction 
    • Markers of myocardial injury   
    • Other laboratory biomarkers        
  • Combined modalities and scores
  • Prognostic assessment strategy

Treatment in the acute phase

  • Haemodynamic and respiratory support
  • Anticoagulation        
    • Parenteral anticoagulation
    • Vitamin K antagonists
    • New oral anticoagulants
  • Thrombolytic treatment         
  • Surgical embolectomy
  • Percutaneous catheter-directed treatment
  • Venous filters
  • Early discharge and outpatient treatment
  • Therapeutic strategies
    • Pulmonary embolism with shock or hypotension (high-risk pulmonary embolism)
    • Pulmonary embolism without shock or hypotension (intermediate- or low-risk pulmonary embolism)

Duration of anticoagulation

  • New oral anticoagulants for extended treatment

Chronic thromboembolic pulmonary hypertension

  • Epidemiology
  • Pathophysiology
  • Clinical presentation and diagnosis
  • Treatment and prognosis

Specific problems

  • Pregnancy
    • Diagnosis of pulmonary embolism in pregnancy
    • Treatment of pulmonary embolism in pregnancy
  • Pulmonary embolism and cancer
    • Diagnosis of pulmonary embolism in patients with cancer
    • Prognosis of pulmonary embolism in patients with cancer
    • Management of pulmonary embolism in patients with cancer
    • Occult cancer presenting as unprovoked pulmonary embolism
  • Non-thrombotic pulmonary embolism
    • Septic embolism
    • Foreign-material pulmonary embolism
    • Fat embolism
    • Air embolism
    • Amniotic fluid embolism
    • Tumour embolism