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Management of pulmonary embolism: recent evidence and the new European guidelines

Stavros V. Konstantinides, Adam Torbicki
European Respiratory Journal 2014 44: 1385-1390; DOI: 10.1183/09031936.00180414
Stavros V. Konstantinides
Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, GermanyDept of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
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Adam Torbicki
Dept of Pulmonary Circulation and Thromboembolic Diseases, Center of Postgraduate Medical Education, ECZ-Otwock, Otwock, Poland
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Venous thromboembolism (VTE), which encompasses deep vein thrombosis and its most dangerous complication, acute pulmonary embolism (PE), represents a major threat for the health, the well-being and, under certain circumstances, the life of a large number of patients worldwide. With its acute and long-term complications, VTE also poses a substantial economic burden on national health systems. Alarmingly, since the risk of VTE approximately doubles with each decade after 40 years of age, it is to be expected that an ever larger number of individuals in “industrialised”, ageing societies will be diagnosed with the disease in the years to come. In 2014, the results of landmark clinical trials and cohort studies, particularly those published in the preceding 6 years, were included in the update of the European Society of Cardiology (ESC) guidelines on the management of PE [1]. In the 2014 ESC guidelines, which were endorsed by the European Respiratory Society (ERS), several recommendations regarding diagnostic strategies and algorithms were retained and their validity reinforced and extended. In parallel, new data extending our knowledge with regards to optimal risk assessment and risk-adapted patient treatment led to major revisions in the recommendations in these latter areas, and new sections on the long-term sequelae of PE as well as its management in specific patient populations were added. The present article summarises and highlights the most relevant new aspects of the 2014 version as compared with the previous European guidelines published in 2008.

Simplification of clinical prediction rules and age-adjusted D-dimer cut-offs

Despite the limited sensitivity and specificity of individual symptoms, signs and common “baseline” clinical tests, the combination of findings evaluated by clinical judgement or by the use of standardised prediction rules allows us to classify patients with suspected PE into distinct categories of clinical, or pre-test, probability of the disease. Recently, both the Wells and the revised Geneva clinical …

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Management of pulmonary embolism: recent evidence and the new European guidelines
Stavros V. Konstantinides, Adam Torbicki
European Respiratory Journal Dec 2014, 44 (6) 1385-1390; DOI: 10.1183/09031936.00180414

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Management of pulmonary embolism: recent evidence and the new European guidelines
Stavros V. Konstantinides, Adam Torbicki
European Respiratory Journal Dec 2014, 44 (6) 1385-1390; DOI: 10.1183/09031936.00180414
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  • Article
    • Simplification of clinical prediction rules and age-adjusted D-dimer cut-offs
    • Persisting uncertainty in subsegmental and incidental PE
    • Advanced risk stratification of PE presenting without shock or persistent hypotension
    • Treatment and secondary prophylaxis of VTE with the new direct oral anticoagulants
    • Efficacy and safety of reperfusion treatment for patients at intermediate risk
    • Early discharge and home (outpatient) treatment of PE
    • A new management algorithm for PE
    • Current diagnosis and treatment of chronic thromboembolic pulmonary hypertension
    • PE in specific patient populations
    • Conclusions
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    • References
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