Current Management of Acute Pulmonary Embolism

Ann Thorac Cardiovasc Surg. 2020 Apr 20;26(2):65-71. doi: 10.5761/atcs.ra.19-00158. Epub 2019 Oct 5.


Purpose: Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prompt diagnosis and management. While non-surgical approaches have supplanted surgery as primary treatment, surgical pulmonary embolectomy (SPE) remains a vital option for select patients. We review the current management of acute PE, with a focus on surgical therapy.

Methods: A PubMed search was performed to identify literature regarding PE and treatment. Results were filtered to include the most comprehensive publications over the past decade.

Results: PE is stratified based on presenting hemodynamic status or degree of mechanical pulmonary arterial occlusion. Although systemic or catheter-guided fibrinolysis is the preferred first-line treatment for the majority of cases, patients who are not candidates should be considered for SPE. Studies demonstrate no mortality benefit of thrombolysis over surgery. Systemic anticoagulation is a mainstay of treatment regardless of intervention approach. Following surgical embolectomy, direct oral anticoagulants (DOACs) have been shown to reduce recurrence of thromboembolism.

Conclusions: Acute PE presents with varying degrees of clinical stability. Patients should be evaluated in the context of various available treatment options including medical, catheter-based, and surgical interventions. SPE is a safe and appropriate treatment option for appropriate patients.

Keywords: catheter thrombolysis; fibrinolysis; pulmonary embolism; surgical pulmonary embolectomy.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Embolectomy* / adverse effects
  • Embolectomy* / mortality
  • Hemodynamics
  • Humans
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / mortality
  • Pulmonary Embolism / physiopathology
  • Pulmonary Embolism / therapy*
  • Recurrence
  • Risk Factors
  • Thrombolytic Therapy* / adverse effects
  • Thrombolytic Therapy* / mortality
  • Treatment Outcome


  • Anticoagulants