Dilemmas in management of pulmonary embolism

Background. Acute pulmonary embolism (PE) is very heterogeneous disease regarding etiology and clinical presentation. Because of that the treatment of PE need multidisciplinary approach creating locally pulmonary embolism response teams (PERT) to deal with various problems associated with PE management. Review. We try to review some unresolved issues in the management of PE, through the diagnostic, reperfusion, anticoagulation and subgroups treatments. In spite of the recent advancement in oral anticoagulation therapy for venous thromboembolism, risk stratification and diagnosis of chronic thromboembolic pulmonary hypertension, all build in the 2019 European Society of Cardiology guidelines, many important obstacles in PE treatment remained. Unlike acute coronary syndrome, PE field is lacking randomized clinical trials and many important questions are opened in front of everyday practice. Conclusion. There are many unmet needs in PE management and we need a lot of randomized trials or data from large registries to resolve some burning problems in the handling of PE patients.