Ch Chairperson: Ch Chairperson: airperson: Adam Torbicki Warsaw - PowerPoint PPT Presentation

Ch Chairperson: Ch Chairperson: airperson: Adam Torbicki Warsaw Poland airperson: Adam Torbicki, Warsaw, Poland ESC Guidelines on Acute Pulm onary Em bolism (1) (1) ESC Guidelines on Acute Pulm onary Em bolism

ESC Guidelines on Acute Pulm onary Em bolism (2) (2) ESC Guidelines on Acute Pulm onary Em bolism

Risk ‐ and Severity ‐ Adjusted Strategy ESC Guidelines on Acute Pulm onary Em bolism (3) (3) ESC Guidelines on Acute Pulm onary Em bolism

BNP - brain natruretic peptide, NT-proBNP - N-terminal proBNP * Defined as a systolic blood pressure < 90 mmHg or a pressure drop of > 40 mmHg for > 15 minutes if not caused by new-onset arrhythmia, hypovolaemia or sepsis. ** Heart-type fatty-acids binding protein (H-FABP) is an emerging marker in this category, but still requires confirmation. ESC Guidelines on Acute Pulm onary Em bolism (4) (4) ESC Guidelines on Acute Pulm onary Em bolism

Severity of Pulmonary Embolism y y ESC Guidelines on Acute Pulm onary Em bolism (5) (5) ESC Guidelines on Acute Pulm onary Em bolism

Severity of Pulmonary Embolism y y ESC Guidelines on Acute Pulm onary Em bolism (6) (6) ESC Guidelines on Acute Pulm onary Em bolism

Severity of Pulmonary Embolism y y ESC Guidelines on Acute Pulm onary Em bolism (7) (7) ESC Guidelines on Acute Pulm onary Em bolism

Risk ‐ Adjusted Treatment Strategy j gy ESC Guidelines on Acute Pulm onary Em bolism (8) (8) ESC Guidelines on Acute Pulm onary Em bolism

I nitial Risk Stratification I nitial Risk Stratification ESC Guidelines on Acute Pulm onary Em bolism (9) (9) ESC Guidelines on Acute Pulm onary Em bolism

Diagnostic Assessm ent ( 1 ) Diagnostic Assessm ent ( 1 ) * CT is considered not immediately available also if critical condition of a patient allows only bedside diagnostic tests. ** Note that transesophageal echocardiography may detect thrombi in the pulmonary arteries in a significant proportion of patients with RV overload and PE ultimately confirmed at spiral CT and that confirmation of DVT with bedside CUS might also help in decision making. ESC Guidelines on Acute Pulm onary Em bolism (10) (10) ESC Guidelines on Acute Pulm onary Em bolism

Diagnostic Assessm ent ( 2 ) Diagnostic Assessm ent ( 2 ) ESC Guidelines on Acute Pulm onary Em bolism (11) (11) ESC Guidelines on Acute Pulm onary Em bolism

ESC Guidelines on Acute Pulm onary Em bolism (12) (12) ESC Guidelines on Acute Pulm onary Em bolism

ESC Guidelines on Acute Pulm onary Em bolism (13) (13) ESC Guidelines on Acute Pulm onary Em bolism

ESC Guidelines on Acute Pulm onary Em bolism (14) (14) ESC Guidelines on Acute Pulm onary Em bolism

Validated diagnostic criteria for patients w ithout shock Validated diagnostic criteria for patients w ithout shock and hypotension according to clinical probability and hypotension according to clinical probability appropriate app op ate inappropriate No definitive data ESC Guidelines on Acute Pulm onary Em bolism (15) (15) ESC Guidelines on Acute Pulm onary Em bolism

Validated diagnostic criteria for patients w ithout shock Validated diagnostic criteria for patients w ithout shock and hypotension according to clinical probability and hypotension according to clinical probability ESC Guidelines on Acute Pulm onary Em bolism (16) (16) ESC Guidelines on Acute Pulm onary Em bolism

Com prehensive Risk Com prehensive Risk Stratification Stratification ESC Guidelines on Acute Pulm onary Em bolism (17) (17) ESC Guidelines on Acute Pulm onary Em bolism

I nitial I nitial Treatm ent Treatm ent Treatm ent Treatm ent ESC Guidelines on Acute Pulm onary Em bolism (18) (18) ESC Guidelines on Acute Pulm onary Em bolism

ESC Guidelines on Acute Pulm onary Em bolism (19) (19) ESC Guidelines on Acute Pulm onary Em bolism

ESC Guidelines on Acute Pulm onary Em bolism (20) (20) ESC Guidelines on Acute Pulm onary Em bolism

� � � � � � � � � � ESC Guidelines on Acute Pulm onary Em bolism (21) (21) ESC Guidelines on Acute Pulm onary Em bolism

� � � � � � ESC Guidelines on Acute Pulm onary Em bolism (22) (22) ESC Guidelines on Acute Pulm onary Em bolism

* Once-daily injection of enoxaparin at the dosage of 1.5 mg/kg is approved for inpatient (hospital) treatment of PE in the United States and in some, but not all, European countries. ESC Guidelines on Acute Pulm onary Em bolism (23) (23) ESC Guidelines on Acute Pulm onary Em bolism

* Once-daily injection of enoxaparin at the dosage of 1.5 mg/kg is approved for inpatient (hospital) treatment of PE in the United States and in some, but not all, European countries. ESC Guidelines on Acute Pulm onary Em bolism (24) (24) ESC Guidelines on Acute Pulm onary Em bolism

Inferior Vena Cava Filters for PE Inferior Vena Cava Filters for PE Recommendation Class Level IVC filters may be used when there are absolute � � contraindications to anticoagulation and a high risk of contraindications to anticoagulation and a high risk of IIb IIb B B recurrence � � The routine use of IVC filters in patients with PE is not p III III B B recommended ESC Guidelines on Acute Pulm onary Em bolism (25) (25) ESC Guidelines on Acute Pulm onary Em bolism

Long Long Long Long Term Term Treatm ent Treatm ent Treatm ent Treatm ent ESC Guidelines on Acute Pulm onary Em bolism (26) (26) ESC Guidelines on Acute Pulm onary Em bolism

ESC Guidelines on Acute Pulm onary Em bolism (27) (27) ESC Guidelines on Acute Pulm onary Em bolism

ESC Guidelines on Acute Pulm onary Em bolism (28) (28) ESC Guidelines on Acute Pulm onary Em bolism

Ch Chairperson: Ch Chairperson: airperson: Adam Torbicki Warsaw Poland airperson: Adam Torbicki, Warsaw, Poland ESC Guidelines on Acute Pulm onary Em bolism (29) (29) ESC Guidelines on Acute Pulm onary Em bolism

ESC Task Force Section Editors Meetting P Paris, January 2008 i J 2008 P.Pruszczyk A. Perrier G.Agnelli S. Konstantinides d N. Galie l A. Torbicki b k J-P. Bassand d ESC Guidelines on Acute Pulm onary Em bolism (30) (30) ESC Guidelines on Acute Pulm onary Em bolism