Main recommendations for initial treatment of pulmonary embolism (PE)
| In patients with confirmed high risk PE (ie, with shock or hypotension) | |
| ICCU admission | Is recommended |
| Bolus and weight adjusted intravenous UFH infusion | Is recommended |
| Vasopressive drugs to correct hypotension | Is recommended |
| Oxygen to correct hypoxaemia | Is recommended |
| Thrombolytic treatment | Is recommended |
| Surgical embolectomy | Is recommended* |
| Catheter embolectomy/fragmentation | May be considered* |
| In patients with confirmed intermediate risk PE (ie, normotensive but with RV dysfunction and/or myocardial injury) | |
| Weight adjusted subcutaneous LMWH or fondaparinux | Are recommended |
| Intravenous UFH infusion if high bleeding risk/low GFR | Is recommended |
| Admission to ICCU and thrombolytic treatment | May be considered |
| In patients with confirmed low risk PE (ie, normotensive with neither RV dysfunction nor myocardial injury) | |
| Weight adjusted subcutaneous LMWH or fondaparinux | Are recommended |
| Intravenous UFH infusion if high bleeding risk/low GFR | Is recommended |
| Home treatment after excluding comorbidities | May be considered |
| In patients with confirmed PE and haemorrhagic complications or PE recurrence despite treatment | |
| Permanent or retrievable vena cava filter | Should be considered |
↵* If thrombolysis fails or is contraindicated.
GFR, glomerular filtration rate; ICCU, intensive cardiac care unit; LMWH, low molecular weight heparins; RV, right ventricle; UFH, unfractionated heparin.