Acute pulmonary embolism revisited

Acute pulmonary embolism (PE) is of interest to physicians of almost all disciplines, as it is encountered across the entire spectrum of clinical medicine. It is estimated that as many as 200 000 patients die annually from PE in the European Union, with similar numbers reported in the USA. In the past, management of acute PE has been characterised by a high degree of complexity and a disappointing lack of efficacy and efficiency. Complex multistep diagnostic algorithms were successfully tested in management studies, but proved extremely difficult to implement correctly in clinical practice. As a result, the diagnosis of PE was frequently missed in patients who subsequently died of the disease without receiving appropriate treatment, while others unnecessarily underwent hazardous, time consuming and costly procedures because of a vague, poorly documented clinical suspicion. With regard to PE treatment, a more than 30-year-old debate and the lack of adequate data on the appropriate indications for thrombolysis have deprived some patients of potentially life saving treatment, while exposing others to the high bleeding risk of thrombolytic drugs.