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Management of intermediate- and high-risk pulmonary embolism-a case of a pregnant patient

Wilhelmina J E Stenger1, Adriaan O Kraaijeveld2, Thijs E van Mens1

  • 1Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.

Journal of Thrombosis and Haemostasis : JTH
|June 26, 2026
PubMed

Insights

Severe acute pulmonary embolism (PE) management is complex, especially in pregnant women lacking specific guidelines. This review offers an approach to treating high-risk PE in this vulnerable population.

Area of Science:

  • Cardiology
  • Pulmonology
  • Obstetrics

Background:

  • Acute pulmonary embolism (PE) presents heterogeneously, from mild symptoms to shock.
  • Severe PE management requires multidisciplinary expertise, ideally via Pulmonary Embolism Response Teams (PERTs).
  • Pregnant women are often excluded from trials, leaving a gap in severe PE guidelines.

Purpose of the Study:

  • To provide an overview of managing severe acute PE.
  • To focus on the specific challenges and approach for pregnant patients with high-risk PE.
  • To offer guidance in the absence of specific trial-based recommendations.

Main Methods:

  • Case-based narrative review.
  • Comprehensive case description of a pregnant patient with high-risk PE.
  • Integration of multidisciplinary expertise principles.

Main Results:

  • Severe PE requires thorough assessment for diagnosis and prognosis.
  • PERTs offer optimal management by integrating diverse expertise.
  • A tailored approach is crucial for pregnant patients with high-risk PE.

Conclusions:

  • Managing severe PE, particularly in pregnant women, necessitates a specialized, multidisciplinary approach.
  • Expert-PE care/PERTs are vital for optimizing outcomes in severe PE.
  • Further research is needed to develop specific guidelines for pregnant women with severe PE.

Keywords:
patient care teampregnancypulmonary embolismtreatment

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