Pulmonary embolus

Pulmonary embolism (PE) remains a common problem and can present with nonspecific symptoms and signs. Anticoagulation is the mainstay of management, the duration of which often depends on the clinical circumstances of the PE.

The aim of this article is to review the epidemiology, clinical presentation, diagnosis, management and long-term complications of PE.

The incidence of PE appears to be increasing worldwide. Common risk factors include recent surgery, trauma, malignancy and oestrogen exposure. Diagnosis relies on a combination of clinical findings, laboratory tests and radiological imaging, often incorporating clinical prediction tools. Objectively confirmed PE requires anticoagulation, usually with a direct oral anticoagulant (DOAC), of at least three months' duration, but indefinite anticoagulation is being considered increasingly because of the heightened risk for recurrence following anticoagulation cessation, and overall safety of DOACs. Chronic thromboembolic pulmonary hypertension is rare but associated with significant morbidity and mortality.