BACKGROUND: Acute pulmonary embolism (PE) is a life-threatening condition that has been treated with anticoagulation for almost 50 years. OBJECTIVES: To review the current treatment options for PE and discuss recently published new features. METHODS: We reviewed literature involving the treatment strategies for venous thromboembolism (VTE) and in particular pulmonary embolism. Specific attention was drawn towards the evidence of the present treatment and of drugs being studied in Phase III trials. RESULTS/CONCLUSIONS: Treatment of acute PE consists of parenteral administration of heparin, low-molecular-weight heparin or fondaparinux overlapped and followed by oral vitamin K antagonists for a minimum of 3 months. Contemporary features include the emergence of new anticoagulant drugs such as oral synthetic inhibitors of thrombin or factor Xa. The duration of anticoagulation for unprovoked VTE remains highly debated.