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

Ch Chairperson: airperson: Adam Torbicki Warsaw Poland Ch Chairperson: airperson: Adam Torbicki, Warsaw, Poland

ESC Guidelines on Acute Pulm onary Em bolism 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)

Risk‐ and Severity‐Adjusted Strategy

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (3)

(3)

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

• r 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 ESC Guidelines on Acute Pulm onary Em bolism (4)

(4)

Severity of Pulmonary Embolism y y

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (5)

(5)

Severity of Pulmonary Embolism y y

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (6)

(6)

Severity of Pulmonary Embolism y y

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (7)

(7)

Risk‐Adjusted Treatment Strategy j gy

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (8)

(8)

I nitial Risk Stratification I nitial Risk Stratification

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (9)

(9)

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 ESC Guidelines on Acute Pulm onary Em bolism (10)

(10)

Diagnostic Assessm ent ( 2 ) Diagnostic Assessm ent ( 2 )

ESC Guidelines on Acute Pulm onary Em bolism 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)

Validated diagnostic criteria for patients w ithout shock and hypotension according to clinical probability Validated diagnostic criteria for patients w ithout shock and hypotension according to clinical probability

appropriate app op ate inappropriate No definitive data

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (15)

(15)

Validated diagnostic criteria for patients w ithout shock and hypotension according to clinical probability Validated diagnostic criteria for patients w ithout shock and hypotension according to clinical probability

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (16)

(16)

Com prehensive Risk Com prehensive Risk Stratification Stratification

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (17)

(17)

I nitial Treatm ent I nitial Treatm ent Treatm ent Treatm ent

ESC Guidelines on Acute Pulm onary Em bolism 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)

* 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 ESC Guidelines on Acute Pulm onary Em bolism (23)

(23)

* 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 ESC Guidelines on Acute Pulm onary Em bolism (24)

(24)

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 IIb B

• contraindications to anticoagulation and a high risk of

recurrence IIb B The routine use of IVC filters in patients with PE is not III B

• p

recommended III B

• ESC Guidelines on Acute Pulm onary Em bolism

ESC Guidelines on Acute Pulm onary Em bolism (25)

(25)

Long Long Long Term Treatm ent Long Term Treatm ent Treatm ent Treatm ent

ESC Guidelines on Acute Pulm onary Em bolism 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)

Ch Chairperson: airperson: Adam Torbicki Warsaw Poland Ch Chairperson: airperson: Adam Torbicki, Warsaw, Poland

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (29)

(29)

ESC Task Force

Section Editors Meetting P i J 2008 Paris, January 2008

d P.Pruszczyk l

• A. Perrier

b k G.Agnelli d

ESC Guidelines on Acute Pulm onary Em bolism ESC Guidelines on Acute Pulm onary Em bolism (30)

(30)

• S. Konstantinides
• N. Galie
• A. Torbicki

J-P. Bassand