Risk Management in Acute Pulmonary Embolism

Pulmonary embolism (PE) is a common disease in clinical practice, burdened by high morbidity and mortality. In the last years much evidence has shown that early mortality is related to haemodynamic compromise and/or right heart dysfunction (RHD). About 5-10% of patients with PE presents with shock and should be treated by thrombolysis if not contraindicated and closely monitored. This kind of presentation is commonly known as massive PE; much recently it has been defined as high risk PE according to the most recent European Society of Cardiology (ESC) guidelines based on early mortality risk assessment. In this situation mortality is more than 15%. About 50% of patients with PE are normotensive at the time of presentation and they have neither echocardiographic nor laboratory signs of RHD. This kind of presentation has been defined as non-massive PE or low risk PE by ESC guidelines. Mortality is low, less than 3%, and treatment with low molecular weight heparins or fondaparinux is widely recommended, such as rapid hospital discharge. Between this situations, a window is represented by the patients which are normotensive but with echocardiographic and/or laboratory signs of RHD. This kind of presentation has been defined as sub-massive PE or, much recently, at intermediate risk; 8