ESC 2019 — Updated pulmonary embolism guidelines to include patients with cancer


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

  • Pulmonary embolism (PE) guidelines rolled out by the European Society of Cardiology (ESC) at its 2019 congress include recommendations for patients with cancer and step-by-step diagnosis of acute PE.
  • The full guidelines are available here.
  • Clinicians can also access a pocket version here, or download the ESC mobile pocket guidelines app.

Why this matters

  • These guidelines also emphasize how to gauge PE severity, which is important because the condition often goes overlooked or is underestimated, leading to death, said guidelines task force chair Stavros Konstantinides in a statement.

Key highlights

  • New additions to the recommendations are listed here. 
    • New class I recommendations include indefinite vitamin K antagonist (VKA) treatment in antiphospholipid antibody syndrome and use of oral non-VKAs in eligible patients in the acute phase.
    • Newly included are guidelines on appropriate drugs for patients with cancer, who may need indefinite therapy.
  • Changes from previous guidelines are listed here. 
    • Included is an upgrade of the recommendation for rescue thrombolytic therapy in the setting of hemodynamic deterioration, now class I.
    • D-dimer measurement is now class IIa for inclusion in the rule-out process in pregnancy or postpartum, and the guidelines propose a dedicated diagnostic algorithm for pregnancy.
  • The guidelines propose a specific algorithm for managing high-risk PE.
  • There is also an algorithm for follow-up of acute PE . 
  • Out of style: use of “provoked” or “unprovoked” PE.
  • A summary of what to do and what not to do is available here. 

Additional note