ESC 2019 Guidelines — Acute Pulmonary Embolism

The 2019 guideline is built as a sequence of algorithms, and questions follow that structure closely: clinical probability, D-dimer with its age adjustment, imaging, then risk stratification before any treatment decision.

Risk stratification is where marks are won. Haemodynamic instability is excluded first; after that, a validated severity index places the patient in a class, and right ventricular assessment and biomarkers refine it. The decision about home treatment follows from that structure, not from the anatomical extent of clot on the scan — which is the distractor most often offered.

Anticoagulation is a direct oral anticoagulant for most patients, and the exceptions are examined precisely because they are absolute: pregnancy and lactation, triple-positive antiphospholipid syndrome, severe renal impairment. The pregnancy pathway has its own imaging algorithm with radiation-conscious options, and it appears regularly. Duration of therapy and the follow-up of persistent symptoms complete the topic.