Untimely diagnosis and treatment of severe pulmonary embolism (PE) may be followed by unfavorable outcome in acute stage of disease or development of severe post-embolic pulmonary hypertension in long-term period. The modern clinical guidelines compiled by various medical communities facilitate choosing an appropriate treatment strategy. Nevertheless, the template implementation of the guidelines can lead to negative results.

OBJECTIVE

To demonstrate the need for a multilateral approach based on a combination of prognostic scales, clinical guidelines and medical intuition for the management of patients with acute venous thrombosis complicated by severe PE.

MATERIAL AND METHODS

The authors report a 41-year-old man with tibial fracture complicated by deep venous thrombosis and massive pulmonary embolism. Clinical decisions were made accordingly to the current guidelines for venous thromboembolism management only. Nevertheless, the patient died from recurrent pulmonary embolism after two days of symptomatic treatment. Authors discuss what other possible decisions would have been made to prevent death in this case.

CONCLUSION

Clinical guidelines are not the only tool to make clinical decisions in patients with venous thromboembolism. Clinical experience has to be an important part of effective management of patients with thrombotic events.