Clinical controversies in the management of acute pulmonary embolism: Evaluation of four important but controversial aspects of acute pulmonary embolism management that are still subject of debate and research.

Outside clinical trials, hemodynamically stable PE patients should not be treated with primary reperfusion therapy. Thrombolysis and/or catheter directed therapy are only to be considered as rescue treatment. Subsegmental PE can be left untreated in selected low risk patients, after proximal deep vein thrombosis has been ruled out. Patients with an sPESI or Hestia score of 0 criteria can be treated at home, independent of the presence of RV overload. Lastly, healthcare providers should be aware of the post-PE syndrome and diagnose chronic thromboembolic pulmonary disease (CTEPD) as early as possible. Persistently symptomatic patients without CTEPD benefit from exercise training and cardiopulmonary rehabilitation.