2019 ESC Guidelines on Acute Pulmonary Embolism

The 2019 ESC PE guideline is the most widely used international reference for PE diagnosis, risk stratification, and management.

Evidence-based guideline by ESC expert panel.

Key recommendations: (1) PESI/sPESI for severity; (2) Three-tier risk: high (shock/arrest), intermediate (RV dysfunction ± troponin), low; (3) Massive PE: systemic thrombolysis; (4) Submassive PE: anticoagulation ± rescue thrombolysis if deterioration; (5) DOACs preferred over VKA for most PE; (6) CTEPH follow-up at 3–6 months post-PE.

Know the PE risk stratification (high/intermediate-high/intermediate-low/low), PESI score, and treatment algorithm. DOACs (rivaroxaban, apixaban) are first-line for most PE. Systemic thrombolysis = massive PE only.

Guideline — evidence quality varies. DOAC data in massive PE is limited.