Recent Advances in the Diagnosis and Management of Pulmonary Embolism

Acute pulmonary embolism (PE) is a form of venous thromboembolism (VTE) and has varied clinical manifestations with significant morbidity and mortality. The general population's overall incidence is on the rise due to the increasing availability of D-dimer and computed tomographic pulmonary angiography. The incidence is higher in males than females (58 versus 48 per 100,000, respectively), increasing with age. In the United States, PE accounts for approximately 100,000 deaths annually. Specific populations, including patients with malignancy, pregnant females, hospitalized medical and surgical patients, or patients with total joint replacement, or arthroplasty, are at a higher risk for PE. Patients presenting with hemodynamic compromise due to PE need to be treated with intravenous thrombolytic therapy unless contraindicated, followed by anticoagulation. For over six decades, traditional anticoagulants like unfractionated heparin (UFH) are used for short-term anticoagulation. For patients who require long-term anticoagulation, low molecular weight heparin (LMWH) like enoxaparin and a vitamin K antagonist like warfarin are used to achieve therapeutic anticoagulation. Options for anticoagulation have been expanding steadily over the last decade with the introduction of the first direct oral anticoagulant (DOAC). Since their introduction, DOACs have changed the landscape of anticoagulation. This narrative review aims to summarize for clinicians managing pulmonary embolism (PE) the main recent advances in patient care, including risk stratification, current data regarding the use of thrombolytic treatment, and direct oral anticoagulants.