Managing Acute Pulmonary Embolism Without Haemodynamic Instability
Clinical Scenario
This protocol covers patients presenting with acute pulmonary embolism who remain haemodynamically stable at presentation. In this group, further risk stratification is recommended, as it carries direct implications for whether the patient can be managed with early discharge or requires in-hospital monitoring.
Treatment Approach
Anticoagulation is initiated without delay, with oral anticoagulants recommended as the first choice for eligible patients — the full selection criteria, sequencing, and alternatives are detailed in the complete protocol.
Clinical Goals
- Maintained clinical and haemodynamic stability
- No haemodynamic decompensation or circulatory collapse over the first hours to days
References
DOI: 10.1093/eurheartj/ehz405
- In the absence of haemodynamic instability at presentation, further risk stratification of PE is recommended, as it has implications for early discharge vs. hospitalization or monitoring of the patient.
- Initiation of anticoagulation is recommended without delay in patients with high or intermediate clinical probability of PE, while diagnostic workup is in progress.
- When oral anticoagulation is started in a patient with PE who is eligible for a NOAC (apixaban, dabigatran, edoxaban, or rivaroxaban), a NOAC is recommended in preference to a VKA.
- In this group, patients with signs of RV dysfunction on echocardiography or CTPA, accompanied by a positive troponin test, should be monitored over the first hours or days due to the risk of early haemodynamic decompensation and circulatory collapse.
View source ↗