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.................................................... 15 Supplementary data

Supplementary Data with additional Web Supplementary Tables complementing the full text, as well as section 11 on non-thrombotic PE, are available on the European Heart Journal website and via the ESC website at www.escardio.org/guidelines.

16 Appendix

Author/Task Force Member Affiliations: Cecilia Becattini, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy; He ́ctor Bueno, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; and Cardiology, Hospital Universitario 12 de Octubre & iþ12 Research Institute, Madrid, Spain; CIBERCV, Madrid, Spain; Geert-Jan Geersing, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Veli- Pekka Harjola, Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University, Helsinki University Hospital, Helsinki, Finland; Menno V. Huisman, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands; Marc Humbert, Service de Pneumologie, Hoˆpital Bic^etre, Assistance Publique-Hoˆpitaux de Paris, Univ. Paris-Sud, Universite ́ Paris-Saclay, Le Kremlin-Bic^etre, France; Catriona Sian Jennings, National Heart and Lung Institute (NHLI), Imperial College London, London, United Kingdom; David Jime ́nez, Respiratory Department, Ramon y Cajal Hospital and Alcala University, IRYCIS, Madrid, Spain; Nils Kucher, Angiology, University Hospital, Zurich, Switzerland; Irene Marthe Lang, Cardiology, Medical University of Vienna, Vienna, Austria; Mareike Lankeit, Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charite ́University Medicine Berlin, Berlin, Germany; and Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Clinic

When oral anticoagulation is initiated in a patient with PE who is eligible for a NOAC (apixaban, dabigatran, edoxaban, or rivaroxaban), prefer a NOAC. I As an alternative to a NOAC, administer a VKA, overlapping with parenteral anticoagulation until an INR of 2.5 (range 2.03.0) has been reached. I Administer rescue thrombolytic therapy to a patient with haemodynamic deterioration on anticoagulation treatment. I Do not use NOACs in patients with severe renal impairment or in those with antiphospholipid antibody syndrome. III Do not routinely administer systemic thrombolysis as primary treatment in patients with intermediate- or low-risk PE. III Do not routinely use inferior vena cava filters. III Chronic treatment and prevention of recurrence Administer therapeutic anticoagulation for >_3 months to all patients with PE. I Discontinue therapeutic oral anticoagulation after 3 months in patients with first PE secondary to a major transient/reversible risk factor. I Continue oral anticoagulant treatment indefinitely in patients presenting with recurrent VTE (at least one previous episode of PE or DVT) that is not related to a major transient or reversible risk factor. I Continue oral anticoagulant treatment with a VKA indefinitely in patients with antiphospholipid antibody syndrome. I In patients who receive extended anticoagulation, reassess drug tolerance and adherence, hepatic and renal function, and the bleeding risk at regular intervals. I PE in pregnancy Perform formal diagnostic assessment with validated methods if PE is suspected during pregnancy or in the post-partum period. I Administer therapeutic, fixed doses of LMWH, based on early pregnancy weight, in the majority of pregnant women without haemodynamic instability. I Do not insert a spinal or epidural needle within 24 h since the last LMWH dose. III Do not administer LMWH within 4 h of removal of an epidural catheter. III Do not use NOACs during pregnancy or lactation. III Post-PE care and long-term sequelae Routinely re-evaluate patients 36 months after acute PE. I Implement an integrated model of care after acute PE, in order to ensure optimal transition from hospital to ambulatory care. I Refer symptomatic patients with mismatched perfusion defects on V/Q lung scan beyond 3 months after acute PE to a pulmonary hypertension/CTEPH expert centre, taking into account the results of echocardiography, natriuretic peptide, and/or cardiopulmonary exercise testing. I

CT = computed tomography; CTPA = computed tomographic pulmonary angiography/angiogram; CTEPH = Chronic thromboembolic pulmonary hypertension; CUS = compression ultrasonography; DVT = deep vein thrombosis; INR = international normalized ratio; LMWH = low-molecular weight heparin; MRA = magnetic resonance angiography; NOAC(s) = non-vitamin K antagonist oral anticoagulant(s); PE = pulmonary embolism; UFH = unfractionated heparin; VKA = vitamin K antagonist; V/Q = ventilation/ perfusion (lung scintigraphy); VTE = venous thromboembolism. aClass of recommendation. Downloaded from academic.oup.com/eurheartj/article/41/4/543/5556136 by guest on 07 October 2026