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● PE is responsible for 10% of hospitalization-related mortality! Treatment with a low molecular weight heparin s.c. or with fondaparinux s.c. should be started based on clinical symptoms i.e. without delay for confirmatory diagnostics.
● Due to the absence of comparative study data, unfractionated heparin continues to be used in patients with the highest risk of mortality. It is also preferred in cases of high bleeding risk (best response to the antidote protamine) and during renal failure.
● Patients with a high risk of mortality are sometimes treated with thrombolytics or thrombectomy.
● Heparin or fondaparinux are commenced together with warfarin/phenprocoumon and may be discontinued once a stable INR of >2.0 has been reached, but not earlier than after 5 days. Warfarin/phenprocoumon is continued during the obligatory secondary thromboprophylaxis of variable length. Three months suffice after a first event with a known provoking factor (e.g. immobilization or post-surgery). A second or more pulmonary embolism requires life-long anticoagulation.
● Both treatment (3 weeks) and the lower-dose secondary prophylaxis can be conducted with a new oral anticoagulant such as rivaroxaban which, in addition to reducing bleedings eliminates the need for thrombocyte and (in some patients) factor Xa activity monitoring as well as warfarin/phenprocoumon dosage finding and INR measurements.