New anticoagulants emerge, how can we use them for acute pulmonary embolism?

A patient with acute pulmonary embolism (PE) is a challenge to the clinician because most treatments increase the risk for bleeding complications. Eighty percent of patients with PE have identifiable predisposing factors, while idiopathic or unprovoked PE was about 20% in the International Cooperative Pulmonary Embolism Registr y (ICOPER) (1). PE and deep vein thrombosis (DVT) share the same predisposing factors, where the strongest setting-related predisposing factor is major surgery (2) and therefore, PE is a well-known and feared complication following surgery with a mortality up to 50% for massive pulmonary embolism (3).