Pulmonary embolism

Also known as: PE · VTE

Also relevant to RespiratoryAlso relevant to Hematology & Oncology

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United StatesACC/AHA

Current

Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report (2021)

CHEST (ACCP) · 2021 · 2021 (Second Update)

The current US antithrombotic-therapy guidance for venous thromboembolism, from the American College of Chest Physicians. It updates the 2016 CHEST guideline.

Recommends direct oral anticoagulants over vitamin K antagonists for VTE without associated cancer. source
Frames therapy as an initiation phase, a 3-month treatment phase, and an extended phase for selected patients. source

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EuropeESC

Current

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism

ESC (with ERS) · 2019

The current European guideline for acute pulmonary embolism, developed with the European Respiratory Society. It centres on risk stratification to guide treatment intensity.

Uses validated risk stratification (e.g. clinical scores, RV assessment, biomarkers) to guide management. source
Recommends direct oral anticoagulants as first-line therapy for most patients without contraindications. source

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US vs EU key differences

Both the US (CHEST 2021) and EU (ESC 2019) guidance favour direct oral anticoagulants over vitamin K antagonists for most non-cancer VTE. source
The US CHEST document is a focused antithrombotic-therapy guideline; the ESC guideline is broader, covering diagnosis and risk stratification of acute PE as well as treatment. source

What changed recently

US2016 (First Update) → 2021 (Second Update)2021-08-02
This second update revises the 2016 CHEST VTE guideline, adding four previously unaddressed questions and substantially modifying eight earlier statements across 32 guidance statements. It also introduces explicit phase-of-anticoagulation nomenclature, separating an initiation phase of about 5 to 21 days from a treatment phase of roughly 12 weeks.
source ↗curation confidence 90%
EU2014 → 20192019-08-31
Updating the 2014 ESC guideline, the 2019 version makes direct oral anticoagulants the first-line treatment (Class I) except in severe renal impairment, pregnancy or antiphospholipid syndrome, supports early discharge and home treatment for carefully selected low-risk patients, and adds a structured 3 to 6 month follow-up pathway to detect post-PE dyspnoea and chronic thromboembolic pulmonary hypertension.
source ↗curation confidence 90%

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