What are the AHA guidelines for the management of acute pulmonary embolism (PE)?

Updated: Jun 06, 2019
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

In 2011, guidelines to help emergency department and other physicians determine which patients with venous thromboembolism (VTE) should receive advanced therapies rather than simple anticoagulation were issued by the American Heart Association (AHA). [104] Recommendations for management of acute pulmonary embolism (PE) are as follows:

  • Therapeutic anticoagulation with subcutaneous low-molecular-weight heparin (LMWH), intravenous or subcutaneous unfractionated heparin (UFH) with monitoring, unmonitored weight-based subcutaneous UFH, or subcutaneous fondaparinux should be given to patients with objectively confirmed PE and no contraindications to anticoagulation (class I).
  • Therapeutic anticoagulation during the diagnostic workup should be given to patients with intermediate or high clinical probability of PE and no contraindications to anticoagulation (class I).
  • Fibrinolysis is reasonable for patients with massive acute PE and acceptable risk of bleeding complications (class IIa).
  • Fibrinolysis may be considered for patients with submassive acute PE judged to have clinical evidence of adverse prognosis (new hemodynamic instability, worsening respiratory insufficiency, severe right ventricular dysfunction, or major myocardial necrosis) and low risk of bleeding complications (class IIb).
  • Fibrinolysis is not recommended for the following patients(class III): (1) Low-risk PE; (2) Submassive acute PE with minor right ventricular dysfunction, minor myocardial necrosis, and no clinical worsening; and (3) With undifferentiated cardiac arrest.

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