ESC Provides New Acute Pulmonary Embolism Guideline

Stavros Konstantinides, MD, PhD

A new, collaborative guideline for acute pulmonary embolism now provides step-by-step diagnostics for the third most common cause of cardiovascular death in Europe.

The new guideline from the European Society of Cardiology (ESC) and European Respiratory Society (ERS)—presented at the ESC Congress 2019 on Saturday—provides clinicians a detailed process to proper diagnosis of the dislodged blood clot condition which results in approximately 350,000 deaths in Europe annually.

It also provides updated insight into the capability of differing embolism screening methods, the duration of care necessary for hospitalized patients, and the therapeutic management of patients with pulmonary embolism and cancer or pregnancy.

Acute pulmonary embolism is characterized by the dislodging of a blood clot in a deep vein—often in the legs—which eventually blocks one more vessels in the lungs. Common risk factors include major surgeries such as knee or hip replacements, serious injuries, prolonged bed rest, cancer, instances of long travel, pregnancy, or instances of women taking the oral contraceptive pill.

Stavros Konstantinides, MD, PhD, FESC, chairperson of the guidelines Task Force and medical director of the Center for Thrombosis and Hemostasis at Johannes Gutenburg University, emphasized the significance of initial and proper diagnosis—an inconsistent event in most thrombosis cases.

“Symptoms including shortness of breath and chest pain resemble other diseases so the diagnosis is often missed, or the severity of the situation is underestimated, and many patients die before getting appropriate therapy," he said in a statement.

According to the guideline, an assessment of symptoms as well as initial results from blood tests should drive a clinician’s pursuit of an acute pulmonary embolism diagnosis. From there, it provides insight into the value of computed tomography (CT) scans for lung vessel visualization, as well as how CT scans compare to lung scans in diagnostic ability and patient radiation exposure.

The guideline also provides advisory on gauging the severity of pulmonary embolism based on a combination of diagnostic and screening results—and as to how these results dictate the use of blood thinners, clot busters, catheter intervention, or invasive care in each patient.

Additionally, the guideline elaborates on the distinction between acute pulmonary embolism and telling signs of chronic thromboembolic pulmonary hypertension (CTEPH)—a disease which differs in therapy options.

Guideline task force members emphasized the significance of following detailed, structured diagnostic measures to uncover the optimized line of care for a condition which is highly prevalent, yet rarely distinguished in cardiovascular patients.

"The aim is to get to the diagnosis as reliably and quickly as possible, in order to start lifesaving therapy and prevent other clots from reaching the lungs," said Guy Meyer, MD, co-chairperson of the guidelines Task Force and a respiratory medicine physician, in a statement.

As with other recently updated clinical guidelines, the 2019 ESC guideline recommends a multidisciplinary, comprehensive network of care delivered to acute pulmonary embolism patients—from their acute phase, to their eventual discharge.

The guideline advises teams be constituted of physicians, qualified nurses, and other allied health professionals involved in the transition from hospital to practitioner care, and experienced in measures of long-term and preventive care.

The European Society of Cardiology Guidelines on acute pulmonary embolism were published online in the European Heart Journal and on the ESC website.