Recent advances in risk stratification and treatment of acute pulmonary embolism

Table 3 Suggested optimal follow-up algorithm in pulmonary embolism

Time point	Assessments/actions	Key considerations/notes
Index event	Baseline clinical assessment. Perform cancer screening (clinical exam, basic labs, chest imaging via CTPA). Bleeding and CV risk assessments	Imaging (e.g., CTPA) is typically available. Begin addressing reproductive considerations for female patients where applicable
4-6 weeks	Conduct follow-up visit(s) for continued bleeding risk assessment. Reassess CV risk. Plan for thrombophilia screening (deferred until 4-6 weeks to avoid false results, especially if on DOACs)	Adjust anticoagulation treatment based on modifiable bleeding risk factors. Thrombophilia screening (especially for antiphospholipid syndrome) should be considered in unprovoked cases
At 3 months	Evaluate functional status and quality of life. Perform CPET if symptoms persist. Screen for post-PE syndrome (new/progressive dyspnea, exercise intolerance). Assess for CTEPH in patients with persistent symptoms	Post-PE syndrome may affect 40%-60% of survivors. CTEPH (affecting 2%-3%) should be ruled out in patients with ongoing dyspnea or right heart failure; referral to expert centers is advised
Long-term follow-up	Periodic follow-up visits: Bleeding and CV risk assessment. Monitor for long-term complications (post-PE syndrome, CTEPH). Provide tailored management for female patients (pregnancy planning, contraceptive guidance). Advise on gradual resumption of physical activity and appropriate travel (e.g., use compression stockings and on-demand prophylactic anticoagulation for long air travel when indicated)	Lifestyle counseling remains crucial for recovery. Regular monitoring ensures timely intervention for evolving complications

CTPA: Computed tomography pulmonary angiogram; CV: Cardiovascular; DOACs: Direct oral anticoagulants; CPET: Cardiopulmonary exercise testing; CTEPH: Chronic thromboembolic pulmonary hypertension.