International Clinical Practice Guideline Recommendations for Acute Pulmonary Embolism: Harmony, Dissonance, and Silence.

Despite abundant clinical innovation and burgeoning scientific investigation, pulmonary embolism (PE) has continued to pose a diagnostic and management challenge worldwide. Aging populations, patients living with a mounting number of chronic medical conditions, particularly cancer, and increasingly prevalent health care disparities herald a growing burden of PE. In the meantime, navigating expanding strategies for immediate and long-term anticoagulation, as well as advanced therapies, including catheter-based interventions for patients with more severe PE, has become progressively daunting. Accordingly, clinicians frequently turn to evidence-based clinical practice guidelines for diagnostic and management recommendations. However, numerous international guidelines, heterogeneity in recommendations, as well as areas of uncertainty or omission may leave the readers and clinicians without a clear management pathway. In this review of international PE guidelines, we highlight key areas of consistency, difference, and lack of recommendations (silence) with an emphasis on critical clinical and research needs.

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Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Outside of the submitted work, Dr Bikdeli is supported by a Career Development Award from the American Heart Association and VIVA Physicians (#938814); was supported by the Scott Schoen and Nancy Adams IGNITE Award; is supported by the Mary Ann Tynan Research Scientist award from the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital, and the Heart and Vascular Center Junior Faculty Award from Brigham and Women’s Hospital; was a consulting expert, on behalf of the plaintiff, for litigation related to 2 specific brand models of IVC filters (he has not been involved in the litigation in 2022-2024 nor has he received any compensation in 2022-2024); is a member of the Medical Advisory Board for the North American Thrombosis Forum; serves in the Data Safety and Monitory Board of the NAIL-IT trial funded by the National Heart, Lung, and Blood Institute, and Translational Sciences; and is a collaborating consultant with the International Consulting Associates and the U.S. Food and Drug Administration in study to generate knowledge about utilization, predictors, retrieval, and safety of IVC filters. Dr Barco has received institutional research support from Boston Scientific, Medtronic, Bayer, and Sanofi; and has received personal fees/honoraria from Boston Scientific, Penumbra, and Viatris. Dr Giannakoulas has received fees for lectures and/or consultations from Actelion/Janssen, Bayer, Boehringer Ingelheim, ELPEN Pharmaceuticals, Ferrer-Galenica, GlaxoSmithKline, Gossamer-Bio, Merck Sharp and Dohme, Pfizer, Lilly, and United Therapeutics. Dr Jimenez has served as a speaker for Bristol Myers Squibb, ROVI, and Sanofi. Dr Lang, in addition to being an investigator in trials involving these companies, has relationships including consultancy service, research grants, and membership of scientific advisory boards for drug companies including AOP-Health, Actelion-Janssen, Merck Sharp and Dohme, United Therapeutics, Medtronic, Neutrolis, and Novo Nordisk; has served as a consultant for AOP Health, Merck Sharp and Dohme, PULNOVO, United Therapeutics, and Janssen; has received grants from AOP Health; and has served on the Speakers Bureau for Merck Sharp and Dohme and Janssen. Dr Klok has received research funding from Bayer, Bristol Myers Squibb, BSCI, AstraZeneca, Merck Sharp and Dohme, Leo Pharma, Actelion, Farm-X, the Netherlands Organisation for Health Research and Development, The Dutch Thrombosis Foundation, The Dutch Heart Foundation, and the Horizon Europe Program, all outside of this work and paid to his institution. Dr Weitz holds the Canada Research Chair (Tier 1) in Thrombosis and the Heart and Stroke Foundation J.F. Mustard Chair in Cardiovascular Research. Dr Piazza has received research grants (paid to his institution) from Bristol Myers Squibb/Pfizer, Janssen, Alexion, Bayer, Amgen, BSC, Esperion, and the National Institutes of Health (1R01HL164717-01); and has received consulting fees for advisory roles from BSC, Amgen, PERC, NAMSA, Bristol Myers Squibb, Janssen, Penumbra, and Thrombolex. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.