Материал: 2019 ESC acute pulmonaryembolism
ESC GUIDELINES
European Heart Journal (2019) 00, 1 61 doi:10.1093/eurheartj/ehz405
2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)
The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)
Authors/Task Force Members: Stavros V. Konstantinides* (Chairperson) (Germany/ Greece), Guy Meyer* (Co-Chairperson) (France), Cecilia Becattini (Italy), He´ctor Bueno (Spain), Geert-Jan Geersing (Netherlands), Veli-Pekka Harjola (Finland), Menno V. Huisman (Netherlands), Marc Humbert1(France),
Catriona Sian Jennings (United Kingdom), David Jime´nez (Spain),
Nils Kucher (Switzerland), Irene Marthe Lang (Austria), Mareike Lankeit (Germany), Roberto Lorusso (Netherlands), Lucia Mazzolai (Switzerland), Nicolas
Meneveau (France), Fionnuala Nı Ainle (Ireland), Paolo Prandoni (Italy), Piotr Pruszczyk (Poland), Marc Righini (Switzerland), Adam Torbicki (Poland),
Eric Van Belle (France), Jose´ Luis Zamorano (Spain)
* Corresponding authors: Stavros V. Konstantinides, Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Building 403, Langenbeckstr. 1, 55131 Mainz, Germany. Tel: þ49 613 117 6255, Fax: þ49 613 117 3456, Email: stavros.konstantinides@unimedizin-mainz.de; and Department of Cardiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece. Email: skonst@med.duth.gr. Guy Meyer, Respiratory Medicine Department, Hoˆpital Europe´en Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France. Tel: þ33 156 093 461, Fax: þ33 156 093 255, Email: guy.meyer@aphp.fr; and Universite´ Paris Descartes, 15 rue de l’e´cole de me´decine 75006 Paris, France.
Author/Task Force Member Affiliations: listed in the Appendix.
ESC Committee for Practice Guidelines (CPG) and National Cardiac Societies document reviewers: listed in the Appendix.
1Representing the ERS.
ESC entities having participated in the development of this document:
Associations: Acute Cardiovascular Care Association (ACCA), Association of Cardiovascular Nursing & Allied Professions (ACNAP), European Association of Cardiovascular Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), Heart Failure Association (HFA).
Councils: Council on Cardiovascular Primary Care.
Working Groups: Aorta and Peripheral Vascular Diseases, Cardiovascular Surgery, Pulmonary Circulation and Right Ventricular Function, Thrombosis.
The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC (journals.permissions@oxfordjournals.org).
Disclaimer. The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
VC The European Society of Cardiology 2019. All rights reserved. For permissions please email: journals.permissions@oup.com.
2019 September 13 on guest by 1093/eurheartj/ehz405/5556136.abstract/doi/10-article-com/eurheartj/advance.oup.https://academic from Downloaded
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ESC Guidelines |
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Document Reviewers: Nazzareno Galie´ (CPG Review Coordinator) (Italy), J. Simon R. Gibbs (CPG Review Coordinator) (United Kingdom), Victor Aboyans (France), Walter Ageno (Italy), Stefan Agewall (Norway), Ana G. Almeida (Portugal), Felicita Andreotti (Italy), Emanuele Barbato (Italy), Johann Bauersachs (Germany), Andreas Baumbach (United Kingdom), Farzin Beygui (France), Jørn Carlsen (Denmark), Marco De Carlo (Italy), Marion Delcroix1 (Belgium), Victoria Delgado (Netherlands), Pilar Escribano Subias (Spain), Donna Fitzsimons (United Kingdom), Sean Gaine1 (Ireland), Samuel Z. Goldhaber (United States of America), Deepa Gopalan (United Kingdom), Gilbert Habib (France), Sigrun Halvorsen (Norway), David Jenkins (United Kingdom), Hugo A. Katus (Germany), Barbro Kjellstro¨ m (Sweden), Mitja Lainscak (Slovenia), Patrizio Lancellotti (Belgium), Geraldine Lee (United Kingdom), Gre´goire Le Gal (Canada), Emmanuel Messas (France), Joao Morais (Portugal), Steffen E. Petersen (United Kingdom),
Anna Sonia Petronio (Italy), Massimo Francesco Piepoli (Italy), Susanna Price (United Kingdom), Marco Roffi (Switzerland), Aldo Salvi (Italy), Olivier Sanchez1 (France), Evgeny Shlyakhto (Russian Federation), Iain A. Simpson (United Kingdom), Stefan Stortecky (Switzerland), Matthias Thielmann (Germany), Anton Vonk Noordegraaf1 (Netherlands)
The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines
For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the Guidelines see https://academic.oup.com/eurheartj/article-lookup/doi/ 10.1093/eurheartj/ehz405#supplementary-data
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Keywords |
Guidelines • pulmonary embolism • venous thrombosis |
• shock • dyspnoea • heart failure • right ven- |
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tricle • diagnosis • risk assessment • echocardiography • biomarkers • treatment • anticoagulation • |
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thrombolysis • pregnancy • venous thromboembolism |
• embolectomy |
Table of contents |
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Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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1 Preamble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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2 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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2.1 Why do we need new Guidelines on the diagnosis and |
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management of pulmonary embolism? . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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2.2 What is new in the 2019 Guidelines? . . . . . . . . . . . . . . . . . . . . . . . . . . |
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2.2.1 New/revised concepts in 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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2.2.2 Changes in recommendations 2014 19 . . . . . . . . . . . . . . . . . . |
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2.2.3 Main new recommendations 2019 . . . . . . . . . . . . . . . . . . . . . . . . |
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3 General considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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3.1 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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3.2 Predisposing factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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3.3 Pathophysiology and determinants of outcome . . . . . . . . . . . . . . . |
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4 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.1 Clinical presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.2 Assessment of clinical (pre-test) probability . . . . . . . . . . . . . . . . . . . |
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4.3 Avoiding overuse of diagnostic tests for pulmonary |
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embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.4 D-dimer testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.4.1 Age-adjusted D-dimer cut-offs . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.4.2 D-dimer cut-offs adapted to clinical probability . . . . . . . . . . . |
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4.4.3 Point-of-care D-dimer assays . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.5 Computed tomographic pulmonary angiography . . . . . . . . . . . . . . |
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4.6 Lung scintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.7 Pulmonary angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.8 Magnetic resonance angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.9 Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.10 Compression ultrasonography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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4.12 Computed tomography venography . . . . . . . . . . . . . . . . . . . . . . . . |
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5 Assessment of pulmonary embolism severity and the risk of |
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early death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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5.1 Clinical parameters of pulmonary embolism severity . . . . . . . . . . |
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5.2 Imaging of right ventricular size and function . . . . . . . . . . . . . . . . . . |
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5.2.1 Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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5.2.2 Computed tomographic pulmonary angiography . . . . . . . . . |
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5.3 Laboratory biomarkers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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5.3.1 Markers of myocardial injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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5.3.2 Markers of right ventricular dysfunction . . . . . . . . . . . . . . . . . . |
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5.3.3 Other laboratory biomarkers . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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5.4 Combined parameters and scores for assessment of |
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pulmonary embolism severity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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5.5 Integration of aggravating conditions and comorbidity |
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into risk assessment of acute pulmonary embolism . . . . . . . . . . . . . . . |
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5.6 Prognostic assessment strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6 Treatment in the acute phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.1 Haemodynamic and respiratory support . . . . . . . . . . . . . . . . . . . . . . |
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6.1.1 Oxygen therapy and ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . |
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ESC Guidelines |
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6.1.2 Pharmacological treatment of acute right ventricular |
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failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.1.3 Mechanical circulatory support and oxygenation . . . . . . . . . . |
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6.1.4 Advanced life support in cardiac arrest . . . . . . . . . . . . . . . . . . . |
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6.2 Initial anticoagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.2.1 Parenteral anticoagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.2.2 Non-vitamin K antagonist oral anticoagulants . . . . . . . . . . . . . |
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6.2.3 Vitamin K antagonists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.3 Reperfusion treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.3.1 Systemic thrombolysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.3.2 Percutaneous catheter-directed treatment . . . . . . . . . . . . . . . |
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6.3.3 Surgical embolectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.4 Multidisciplinary pulmonary embolism teams . . . . . . . . . . . . . . . . . |
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6.5 Vena cava filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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7 Integrated risk-adapted diagnosis and management . . . . . . . . . . . . . . . . |
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7.1 Diagnostic strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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7.1.1 Suspected pulmonary embolism with haemodynamic |
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instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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7.1.2 Suspected pulmonary embolism without haemodynamic |
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instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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7.1.2.1 Strategy based on computed tomographic pulmonary |
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angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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7.1.2.2 Strategy based on ventilation/perfusion |
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scintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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7.2 Treatment strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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7.2.1 Emergency treatment of high-risk pulmonary embolism . . . |
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7.2.2 Treatment of intermediate-risk pulmonary embolism . . . . . |
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7.2.3 Management of low-risk pulmonary embolism: triage |
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for early discharge and home treatment . . . . . . . . . . . . . . . . . . . . . . . |
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8 Chronic treatment and prevention of recurrence . . . . . . . . . . . . . . . . . |
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8.1 Assessment of venous thromboembolism |
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recurrence risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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8.2 Anticoagulant-related bleeding risk . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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8.3 Regimens and treatment durations with non-vitamin |
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K antagonist oral anticoagulants, and with other non-vitamin |
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K antagonist antithrombotic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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8.5 Management of pulmonary embolism in patients |
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with cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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9 Pulmonary embolism and pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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9.1 Epidemiology and risk factors for pulmonary embolism |
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in pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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9.2 Diagnosis of pulmonary embolism in pregnancy . . . . . . . . . . . . . . . |
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9.2.1 Clinical prediction rules and D-dimers . . . . . . . . . . . . . . . . . . . . |
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9.2.2 Imaging tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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9.3 Treatment of pulmonary embolism in pregnancy . . . . . . . . . . . . . . |
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9.3.1 Role of a multidisciplinary pregnancy heart team . . . . . . . . . . |
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9.4 Amniotic fluid embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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10 Long-term sequelae of pulmonary embolism . . . . . . . . . . . . . . . . . . . . . |
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10.1 Persisting symptoms and functional limitation after |
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pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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10.2 Chronic thromboembolic pulmonary hypertension . . . . . . . . . . |
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10.2.1 Epidemiology, pathophysiology, and natural history . . . . . . |
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10.2.2 Clinical presentation and diagnosis . . . . . . . . . . . . . . . . . . . . . . |
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10.2.3 Surgical treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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10.2.4 Balloon pulmonary angioplasty . . . . . . . . . . . . . . . . . . . . . . . . . |
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10.2.5 Pharmacological treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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10.3 Strategies for patient follow-up after pulmonary |
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embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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11 Non-thrombotic pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . |
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12 Key messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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13 Gaps in the evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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14 ‘What to do’ and ‘what not to do’ messages from the |
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Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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15 Supplementary data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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16 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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17 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Recommendations |
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4.11 Recommendations for diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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5.7 Recommendations for prognostic assessment . . . . . . . . . . . . . . . . . . . |
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6.6 Recommendations for acute-phase treatment of high-risk |
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pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.7 Recommendations for acute-phase treatment of intermediate- |
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or low-risk pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.8 Recommendations for multidisciplinary pulmonary embolism |
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teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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6.9 Recommendations for inferior vena cava filters . . . . . . . . . . . . . . . . . . |
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6.10 Recommendations for early discharge and home treatment . . . . . |
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8.4 Recommendations for the regimen and the duration of |
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anticoagulation after pulmonary embolism in patients without |
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cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
35 |
8.6 Recommendations for the regimen and the duration of |
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anticoagulation after pulmonary embolism in patients with active |
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cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
37 |
9.5 Recommendations for pulmonary embolism in pregnancy . . . . . . . |
40 |
10.4 Recommendations for follow-up after acute pulmonary |
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embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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List of tables |
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Table 1 Classes of recommendation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
6 |
Table 2 Levels of evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Table 3 Predisposing factors for venous thromboembolism . . . . . . . . . |
10 |
Table 4 Definition of haemodynamic instability, which delineates |
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acute high-risk pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
11 |
Table 5 The revised Geneva clinical prediction rule for pulmonary |
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embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
12 |
Table 6 Imaging tests for diagnosis of pulmonary embolism . . . . . . . . . . |
14 |
Table 7 Original and simplified Pulmonary Embolism |
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Severity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
20 |
Table 8 Classification of pulmonary embolism severity and the |
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risk of early (in-hospital or 30-day) death . . . . . . . . . . . . . . . . . . . . . . . . . . . |
21 |
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4 |
ESC Guidelines |
|
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Table 9 Treatment of right ventricular failure in acute high-risk pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 10 Thrombolytic regimens, doses, and contra
indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table 11 Categorization of risk factors for venous
thromboembolism based on the risk of recurrence over the
long-term . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 12 Estimated radiation absorbed in procedures used for diagnosing pulmonary embolism (based on various references) . . . . . . 39 Table 13 Risk factors and predisposing conditions for Chronic thromboembolic pulmonary hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
List of figures |
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Figure 1 Trends in annual incidence rates and case fatality rates |
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of pulmonary embolism around the world, based on data |
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retrieved from various references . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
9 |
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Figure 2 Key factors contributing to haemodynamic collapse |
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and death in acute pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
11 |
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Figure 3 Graphic representation of transthoracic |
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echocardiographic parameters in the assessment of right |
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ventricular pressure overload . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
16 |
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Figure 4 Diagnostic algorithm for patients with suspected |
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high-risk pulmonary embolism, presenting with haemodynamic |
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instability . . . . . . |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
28 |
Figure 5 Diagnostic algorithm for patients with suspected |
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pulmonary embolism without haemodynamic instability . . . . . . . . . . . . . |
29 |
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Figure 6 Risk-adjusted management strategy for acute pulmonary |
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embolism . . . . . |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
31 |
Figure 7 Diagnostic workup for suspected pulmonary |
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embolism during pregnancy and up to 6 weeks post-partum . . . . . . . . . |
38 |
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Figure 8 Follow-up strategy and diagnostic workup for |
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long-term sequelae of pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . |
44 |
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Abbreviations and acronyms |
|
|
AcT |
Right ventricular outflow Doppler acceleration |
|
|
time |
|
AFE |
Amniotic fluid embolism |
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ALT |
Alanine aminotransferase |
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AMPLIFY |
Apixaban for the Initial Management of Pulmonary |
|
|
Embolism and Deep-Vein Thrombosis as First-line |
|
|
Therapy |
|
ASPIRE |
Aspirin to Prevent Recurrent Venous |
|
|
Thromboembolism trial |
|
AV |
Arteriovenous |
|
b.i.d |
Bis in die (twice a day) |
|
BNP |
B-type natriuretic peptide |
|
BP |
Blood pressure |
|
BPA |
Balloon pulmonary angioplasty |
|
b.p.m |
Beats per minute |
|
CI |
Confidence interval |
|
CO |
Cardiac output |
|
CPET |
Cardiopulmonary exercise testing |
|
CPG |
Committee for Practice Guidelines |
|
CrCl |
Creatinine clearance |
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CRNM |
Clinically relevant non-major (bleeding) |
CT |
Computed tomogram/tomographic/tomography |
CTED |
Chronic thromboembolic disease |
CTEPH |
Chronic thromboembolic pulmonary hypertension |
CTPA |
Computed tomography pulmonary angiography/ |
|
angiogram |
CUS |
Compression ultrasonography |
CYP3A4 |
Cytochrome 3A4 |
DAMOVES |
D-dimer, Age, Mutation, Obesity, Varicose veins, |
|
Eight [coagulation factor VIII], Sex |
DASH |
D-dimer, Age, Sex, Hormonal therapy |
DVT |
Deep vein thrombosis |
ECMO |
Extracorporeal membrane oxygenation |
ELISA |
Enzyme-linked immunosorbent assay |
EMA |
European Medicines Agency |
ERS |
European Respiratory Society |
ESC |
European Society of Cardiology |
FAST |
H-FABP, Syncope, Tachycardia (prognostic score) |
FDA |
US Food and Drug Administration |
GUSTO |
Global Utilization of Streptokinase and Tissue |
|
Plasminogen Activator for Occluded Coronary |
|
Arteries |
HAS-BLED |
Hypertension, Abnormal renal/liver function, |
|
Stroke, Bleeding history or predisposition, Labile |
|
international normalized ratio, Elderly (>65 years), |
|
Drugs/alcohol concomitantly |
HERDOO2 |
Hyperpigmentation, Edema, or Redness in either |
|
leg; D-dimer level >250 lg/L; Obesity with body |
|
mass index >30 kg/m2; or Older age, >65 years |
H-FABP |
Heart-type fatty acid-binding protein |
HIV |
Human immunodeficiency virus |
HR |
Hazard ratio |
INR |
International normalized ratio |
IU |
International units |
i.v |
Intravenous |
IVC |
Inferior vena cava |
LA |
Left atrium |
LMWH |
Low-molecular weight heparin(s) |
LV |
Left ventricle/ventricular |
MRA |
Magnetic resonance angiography |
NCT |
National clinical trial |
NOAC(s) |
Non-vitamin K antagonist oral anticoagulant(s) |
NT-proBNP |
N-terminal pro B-type natriuretic peptide |
NYHA |
New York Heart Association |
OBRI |
Outpatient Bleeding Risk Index |
o.d |
Omni die (once a day) |
OR |
Odds ratio |
PAH |
Pulmonary arterial hypertension |
PAP |
Pulmonary artery pressure |
PE |
Pulmonary embolism |
PEA |
Pulmonary endarterectomy |
PEITHO |
Pulmonary Embolism Thrombolysis trial |
PERC |
Pulmonary Embolism Rule-out Criteria |
PERT |
Pulmonary Embolism Response Team |
PESI |
Pulmonary Embolism Severity Index |
2019 September 13 on guest by 1093/eurheartj/ehz405/5556136.abstract/doi/10-article-com/eurheartj/advance.oup.https://academic from Downloaded
ESC Guidelines |
5 |
P-gp |
P-glycoprotein |
PH |
Pulmonary hypertension |
PIOPED |
Prospective Investigation On Pulmonary Embolism |
|
Diagnosis |
PISAPED |
Prospective Investigative Study of Acute Pulmonary |
|
Embolism Diagnosis |
PREPIC |
Prevention of Recurrent Pulmonary Embolism by |
|
Vena Cava Interruption |
PVR |
Pulmonary vascular resistance |
RA |
Right atrium/atrial |
RCT |
Randomized controlled trial |
RIETE |
Registro Informatizado de la Enfermedad |
|
Thromboembolica venosa |
RR |
Relative risk |
rtPA |
Recombinant tissue-type plasminogen activator |
RV |
Right ventricle/ventricular |
SaO2 |
Arterial oxygen saturation |
SPECT |
Single-photon emission computed tomography |
sPESI |
Simplified Pulmonary Embolism Severity Index |
SURVET |
Sulodexide in Secondary Prevention of Recurrent |
|
Deep Vein Thrombosis study |
TAPSE |
Tricuspid annular plane systolic excursion |
TOE |
Transoesophageal echocardiography/ |
|
echocardiogram |
TTE |
Transthoracic echocardiography/echocardiogram |
TV |
Tricuspid valve |
U |
Unit |
UFH |
Unfractionated heparin |
VKA(s) |
Vitamin K antagonist(s) |
V/Q |
Ventilation/perfusion (lung scintigraphy) |
VTE |
Venous thromboembolism |
VTE-BLEED |
ActiVe cancer, male with uncontrolled |
|
hyperTension at baseline, anaEmia, history of |
|
BLeeding, agE >60 years, rEnal Dysfunction |
WARFASA |
Warfarin and Aspirin study |
1 Preamble
Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.
A great number of guidelines have been issued in recent years by the European Society of Cardiology (ESC), as well as by other societies and organisations. Because of their impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/Guidelines-&- Education/Clinical-Practice-Guidelines/Guidelines-development/Wri ting-ESC-Guidelines). The ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.
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The ESC carries out a number of registries which are essential to assess, diagnostic/therapeutic processes, use of resources and adherence to Guidelines. These registries aim at providing a better understanding of medical practice in Europe and around the world, based on data collected during routine clinical practice.
The guidelines are developed together with derivative educational material addressing the cultural and professional needs for cardiologists and allied professionals. Collecting high-quality observational data, at appropriate time interval following the release of ESC Guidelines, will help evaluate the level of implementation of the Guidelines, checking in priority the key end points defined with the ESC Guidelines and Education Committees and Task Force members in charge.
The Members of this Task Force were selected by the ESC, including representation from its relevant ESC sub-specialty groups, in order to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for management of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk benefit ratio. The level of evidence and the strength of the recommendation of particular management options were weighed and graded according to predefined scales, as outlined in Tables 1 and 2.
The experts of the writing and reviewing panels provided declaration of interest forms for all relationships that might be perceived as real or potential sources of conflicts of interest. These forms were compiled into one file and can be found on the ESC website (http:// www.escardio.org/guidelines). Any changes in declarations of interest that arise during the writing period were notified to the ESC and updated. The Task Force received its entire financial support from the ESC without any involvement from the healthcare industry.
The ESC CPG supervises and coordinates the preparation of new Guidelines. The Committee is also responsible for the endorsement process of these Guidelines. The ESC Guidelines undergo extensive review by the CPG and external experts. After appropriate revisions the Guidelines are approved by all the experts involved in the Task Force. The finalized document is approved by the CPG for publication in the European Heart Journal. The Guidelines were developed after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating.
The task of developing ESC Guidelines also includes the creation of educational tools and implementation programmes for the recommendations including condensed pocket guideline versions, summary slides, booklets with essential messages, summary cards for non-specialists and an electronic version for digital applications (smartphones, etc.). These versions are abridged and thus, for more detailed information, the user should always access to the full text version of the Guidelines, which is freely available via the ESC website and hosted on the EHJ website. The National Societies of the ESC are encouraged to endorse, translate and implement all ESC Guidelines. Implementation programmes are needed because it has been shown that the outcome of disease may be favourably influenced by the thorough application of clinical recommendations.
Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the
2019 September 13 on guest by 1093/eurheartj/ehz405/5556136.abstract/doi/10-article-com/eurheartj/advance.oup.https://academic from Downloaded