International Clinical Practice Guideline Recommendations for Acute Pulmonary Embolism: Harmony, Dissonance, and Silence (JACC October 2024-2)-Article: International Clinical Practice Guideline Recommendations for Acute Pulmonary Embolism: Harmony, Dissonance, and Silence

Article: International Clinical Practice Guideline Recommendations for Acute Pulmonary Embolism: Harmony, Dissonance, and Silence

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The provided document is a comprehensive review of international clinical practice guidelines for the diagnosis and management of acute pulmonary embolism (PE). Despite advancements in clinical practice and scientific research, PE remains a diagnostic and management challenge worldwide, contributing to significant morbidity and mortality, especially with aging populations and those with chronic conditions like cancer. This necessitates reliance on evidence-based clinical practice guidelines, though discrepancies among various international standards can lead to inconsistencies in treatment approaches.<br /><br />Major points from the guidelines include the recommendation for prompt diagnosis using clinical prediction models and imaging technologies like CT pulmonary angiography. For risk stratification, tools like the Pulmonary Embolism Severity Index (PESI) are endorsed, and patients are categorized into different risk groups to guide treatment pathways.<br /><br />The use of anticoagulants is fundamental in managing PE, with guidelines recommending immediate therapeutic anticoagulation in suspected cases where the bleeding risk is low. Unfractionated heparin is commonly recommended for high-risk cases. For confirmed PE, direct oral anticoagulants are preferred for most patients due to their safety and efficacy. However, detailed recommendations vary, with some regional preferences noted.<br /><br />The document emphasizes the need for multidisciplinary care teams, although not all guidelines specify the specialties involved. Advanced therapeutic interventions like catheter-directed procedures are discussed, but their use remains a topic of debate due to insufficient evidence.<br /><br />Little consensus exists on lifestyle modifications post-PE, despite their potential benefits in mitigating recurrence risk. Similarly, guidelines vary on the use of inferior vena cava filters and follow-up strategies, pointing to significant knowledge gaps that require further research.<br /><br />Overall, the review underscores the critical role of clinical practice guidelines in improving PE care but also highlights substantial areas where further research is urgently needed to harmonize international standards and close gaps in clinical practice.

Keywords

pulmonary embolism

clinical practice guidelines

diagnosis

management

anticoagulants

risk stratification

CT pulmonary angiography

Pulmonary Embolism Severity Index

multidisciplinary care

international standards