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.