The American College of Cardiology (ACC) and the American Heart Association (AHA) recently released an acute pulmonary embolism guideline, with the primary focus of the guideline being the evaluation and management of acute pulmonary embolism in patients 18 years of age and older, covering initial presentation of symptoms, laboratory testing, and the use of imaging to diagnose pulmonary embolism.
The guideline, Evaluation and Management of Acute Pulmonary Embolism in Adults, features more than 100 recommendations spread across four sections covering evaluation and diagnosis, acute management, monitoring and follow-up, and complications and sequelae. The guidelines also feature key take-home messages which we have summarized below, for your convenience.
Key Highlights from the AHA/ACC Acute Pulmonary Embolism Guideline
Pulmonary embolism response teams (PERTs) are recommended to enhance the timeliness of patient care.
The guideline introduces Acute Pulmonary Embolism Clinical Categories, a five-tier system (A-E) with sub-tiers (low to high-risk for adverse outcomes), to enhance the accuracy of classification, assessment, and decision-making for patients presenting with acute PE.
Category A asymptomatic patients with acute PE can be discharged home from the ER without needing to be hospitalized.
Early hospital discharge is recommended for Category B patients with acute PE and who are symptomatic.
Category C/D/E symptomatic patients with acute PE should be hospitalized to optimize treatment strategies.
Advanced therapies (e.g., mechanical thrombectomy and surgical embolectomy) are reasonable for Category E1 patients, and can be considered for Category D1-2 patients.
Low-molecular-weight heparin is recommended over unfractionated heparin in patients with acute PE who require initial parenteral anticoagulant therapy.
Direct oral anticoagulants are recommended over vitamin K antagonists (unless contraindicated) to prevent recurrent VTE and reduce major bleeding in patients with acute PE who are eligible for oral anticoagulation.
Continuing anticoagulation beyond three to six months and into the extended phase is recommended for patients with their first PE without a major reversible risk factor and in patients with a persistent risk factor.
To help screen for chronic thromboembolic pulmonary disease or other causes of functional limitation and dyspnea, patients who experienced acute PE should be questioned about symptoms and functional limitations during visits for at least one year.
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