Abdul Mannan/LinkedIn

Jul 27, 2026, 11:05

Abdul Mannan: CTEPH – The Treatable Cause of Post-PE Breathlessness

Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn:

“Still breathless after PE? Do not blame fitness too quickly.

One question after pulmonary embolism can change a patient’s future:

‘Why are they still breathless?’

Too often, breathlessness after PE is filed under deconditioning. Sometimes that is wrong.

CTEPH, chronic thromboembolic pulmonary hypertension, occurs when clot becomes organised scar tissue in the pulmonary arteries.

Pressure rises. The right ventricle works harder.

But this disease can be treated, and some patients can have surgery that removes the obstructing material.

Here is the simple rule:

New or ongoing exertional breathlessness after 3 months of anticoagulation needs a check. Refer sooner if the patient is deteriorating.
A V/Q scan is the gatekeeper test. Mismatched perfusion defects should trigger referral.
A negative CTPA alone does not rule out distal chronic thromboembolic disease.
Refer to a CTEPH team, not just routine respiratory clinic. They decide on pulmonary endarterectomy, balloon pulmonary angioplasty, medical treatment, or a combination.
Confirmed CTEPH needs lifelong anticoagulation. Test for antiphospholipid syndrome. Use a VKA in thrombotic APS.

As haematologists, we may be the first team to spot this in patients with recurrent VTE, MPN, APS, cancer, splenectomy, or indwelling lines.

The 2022 ESC/ERS pulmonary hypertension guideline gives this a Class I referral pathway.

Which post-PE symptom do you think is most often brushed aside?

2022 ESC/ERS pulmonary-hypertension guideline: confirms V/Q imaging, lifelong anticoagulation in CTEPH, APS testing/VKA in thrombotic APS, expert CTEPH-MDT review, and PEA/BPA/riociguat pathways.
ERS CTEPH statement, 2021: supports the diagnostic and multidisciplinary management framework.”

Abdul Mannan: CTEPH - The Treatable Cause of Post-PE Breathlessness