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However, <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content> will only be confirmed in 10\u201320% of patients. Because the imaging test of choice, computed tomography pulmonary angiography (<jats:styled-content style=\"fixed-case\">CTPA<\/jats:styled-content>), is costly and associated with radiation exposure and other complications, a validated diagnostic algorithm consisting of a clinical decision rule and D\u2010dimer test should be used to safely exclude <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content> in 20\u201330% of patients without the need for <jats:styled-content style=\"fixed-case\">CTPA<\/jats:styled-content>. Recently, the\u00a0age\u2010adjusted D\u2010dimer threshold has been validated, and this has increased the proportion of patients at older age in whom <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content> can be excluded without <jats:styled-content style=\"fixed-case\">CTPA<\/jats:styled-content>. Initial therapeutic management of <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content> depends on the risk of short\u2010term <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content>\u2010related mortality. Haemodynamically unstable patients should be closely monitored and receive thrombolytic therapy unless contraindicated because of an unacceptably high bleeding risk, whereas patients with low\u2010risk <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content> may be safely discharged early from hospital or receive only outpatient treatment. The <jats:styled-content style=\"fixed-case\">PESI<\/jats:styled-content> score and Hestia decision rule are available to select patients in whom early discharge or outpatient treatment will be safe, although the safety of these strategies should be confirmed in additional studies. Standard <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content> therapy consists of low molecular weight heparin (<jats:styled-content style=\"fixed-case\">LMWH<\/jats:styled-content>) followed by vitamin K antagonists (<jats:styled-content style=\"fixed-case\">VKA<\/jats:styled-content>s). Recently, several nonvitamin K\u2010dependent oral anticoagulants have been shown to be as effective as <jats:styled-content style=\"fixed-case\">LMWH<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">VKA<\/jats:styled-content>s, and maybe safer. Determining the optimal duration of treatment for a first unprovoked <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content> remains a challenge, although clinical prediction rules for estimating the risk of recurrence of venous thromboembolism and anticoagulation\u2010associated haemorrhage are under investigation. Using these prediction rules may lead to both more standardized and more individualized long\u2010term treatment of <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content>.<\/jats:p>","DOI":"10.1111\/joim.12404","type":"journal-article","created":{"date-parts":[[2015,8,19]],"date-time":"2015-08-19T07:48:22Z","timestamp":1439970502000},"page":"16-29","source":"Crossref","is-referenced-by-count":18,"title":["Recent developments in the diagnosis and treatment of pulmonary embolism"],"prefix":"10.1111","volume":"279","author":[{"given":"T.","family":"van der Hulle","sequence":"first","affiliation":[{"name":"Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. E. 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