Multidisciplinary management of intermediate and high-risk pulmonary embolism in the era of mechanical thrombectomy: a local practice guideline.

BACKGROUND: Risk stratification and management of pulmonary embolism (PE) continues to evolve, particularly for patients in the intermediate- and high-risk category, where treatment decisions are complicated by patient heterogeneity and limited guidance on reperfusion strategies. Catheter-based therapy (CBT) is becoming commonplace internationally; however, there is no published guidance on a standard approach to when to use these therapies in the Australian setting.

AIM: We aimed to develop a consensus-based, evidence-informed algorithm for risk stratification and management of PE at our institution, with a focus on effective utilisation of CBT.

METHODS: We conducted a retrospective audit of PE patients treated at our hospital. reviewed current evidence and international guidelines and convened a PE working group comprising respiratory physicians, interventional radiologists, intensive care physicians and anaesthetists. This group developed consensus guidelines and a standardised treatment algorithm.

RESULTS: The resulting treatment algorithm provides a clear, evidence-based approach to risk stratifying and managing PE patients, with a particular focus on the intermediate risk group. It facilitates uniform, multidisciplinary, physician-led decision-making and supports safe and effective integration of CBT. This treatment algorithm is novel in the Australian setting.

CONCLUSION: As CBT and other advanced therapies become increasingly available, the absence of national consensus guidelines presents a challenge. By integrating emerging clinical evidence expert opinion, we provide a pragmatic model that may support decision-making in similarly resourced centres.