Assessment, diagnosis and management of pulmonary embolism

This clinical review explores the assessment, diagnosis and management of pulmonary embolism (PE), with a focus on addressing the challenges associated with atypical clinical presentations. It discusses evidence-based practices, clinical presentations, risk factors, treatment options (including thrombolysis, direct oral anticoagulants, warfarin, and low-molecular-weight heparin, along with guidelines on their usage) and pre-test clinical probability assessment tools, such as the Wells score and age-adjusted D-dimer. Diagnostic imaging modalities, including computed tomography pulmonary angiography and ventilation/perfusion scans, are highlighted, with a cautious approach recommended to weigh the advantages and disadvantages of each. Distinctions are made between provoked and unprovoked PE, and appropriate follow-up plans are included. Collectively, this review highlights the need for advanced clinical practitioners to navigate and manage the complexities surrounding PE. While this paper primarily focused on UK-based practices, it integrates global evidence and guidance, acknowledging potential variations in guidance across countries and continents.