PT  - JOURNAL ARTICLE
AU  - Robin Condliffe
AU  - Charlie A Elliot
AU  - Rodney J Hughes
AU  - Judith Hurdman
AU  - Rhona M Maclean
AU  - Ian Sabroe
AU  - Joost J van Veen
AU  - David G Kiely
TI  - Management dilemmas in acute pulmonary embolism
AID  - 10.1136/thoraxjnl-2013-204667
DP  - 2014 Feb 01
TA  - Thorax
PG  - 174--180
VI  - 69
IP  - 2
4099  - http://thorax.bmj.com/content/69/2/174.short
4100  - http://thorax.bmj.com/content/69/2/174.full
SO  - Thorax2014 Feb 01; 69
AB  - Background Physicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent. Methods Fourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested. Results Management dilemmas discussed include: sub-massive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants. Conclusion The suggested approaches are based on a review of the available evidence and guidelines and on our clinical experience. Management in an individual patient requires clinical assessment of risks and benefits and also depends on local availability of therapeutic interventions.