BMJ Best Practice Podcast Pulmonary embolism
14 snips
Mar 30, 2026 
Scott Woller, Director of the Thrombosis Clinic and Professor of Medicine, shares clinical insight on pulmonary embolism. He walks through diagnosis: pretest probability, D-dimer strategies, imaging choices and pitfalls of over-testing. Discussion covers subsegmental PE, anticoagulation choices including DOACs, catheter-directed therapies and questions around intermediate-risk management and treatment duration.
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Choose VQ Scan For Pregnancy Or CKD
- Prefer V/Q scan for patients with pregnancy or advanced kidney disease to avoid contrast CTPA risks.
- Reserve CTPA generally but use V/Q when renal function or fetal exposure is a concern.
Start Anticoagulation Early When Suspicion High
- Start anticoagulation promptly in suspected PE, even before imaging if clinical suspicion is high and diagnosis may be delayed.
- Always balance against individual bleeding risk before empiric anticoagulation.
Prefer LMWH Over Unfractionated Heparin
- Prefer low molecular weight heparin (LMWH) over unfractionated heparin for initial therapy due to more reliable pharmacokinetics and safety.
- Reserve unfractionated heparin mainly for the small subset with life-threatening PE where intervention may be needed.