ESC 2019 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)
European Society of Cardiology｜循環器 / 肺血栓塞栓症｜61 ページ｜チャンク 602｜推奨 70 件｜current
推奨表（自動抽出）
PDF の推奨表から機械的に抽出したものです。引用前に必ず該当ページの原文を確認してください。
| 頁 | クラス | レベル | 推奨文 | 表 |
|---|---|---|---|---|
| p.17 | I | C | gency CTPA (depending on availability and clinical circumstances) is recommended for diagnosis.169 | |
| p.17 | I | B | The use of validated criteria for diagnosing PE is recommended.12 | |
| p.17 | I | A | a validated prediction rule.89,91,92,103,134,170172 | |
| p.17 | IIa | B | considered to exclude PE.107 | |
| p.17 | III | A | D-dimer measurement is not recommended in patients with high clinical probability, as a normal result does not safely exclude PE, even when using a highly sensitive assay.175,176 | |
| p.17 | I | A | mediate clinical probability, or who is PE-unlikely.101,122,164,171 | |
| p.17 | I | B | filling defect in a patient with intermediate or high clinical probability.115 | |
| p.17 | IIa | B | cal probability or who is PE-likely.171 | |
| p.17 | IIb | C | Further imaging tests to confirm PE may be considered in cases of isolated subsegmental filling defects.115 | |
| p.17 | III | B | CT venography is not recommended as an adjunct to CTPA.115,164 | |
| p.17 | I | A | It is recommended to reject the diagnosis of PE (without further testing) if the perfusion lung scan is normal.75,122,134,174 | |
| p.17 | IIa | B | It should be considered to accept that the diagnosis of PE (without further testing) if the V/Q scan yields high probability for PE.134 | |
| p.17 | IIa | B | patients with low clinical probability, or who are PE-unlikely.75,122,174 | |
| p.18 | I | A | cion of PE.164,165 | |
| p.18 | IIa | B | If CUS shows only a distal DVT, further testing should be considered to confirm PE.177 | |
| p.18 | IIa | C | management.178,179 | |
| p.18 | III | A | MRA is not recommended for ruling out PE.139,140 | |
| p.22 | I | B | Initial risk stratification of suspected or confirmed PE, based on the presence of haemodynamic instability, is recommended to identify patients at high risk of early mortality.218,219,235 | |
| p.22 | I | B | risk categories is recommended.179,218,219,235 | |
| p.22 | IIa | B | In patients without haemodynamic instability, use of clinical prediction rules integrating PE severity and comorbidity, preferably the PESI or sPESI, should be considered for risk assessment in the acute phase of PE.178,226,229 | |
| p.22 | IIa | B | low PESI or a negative sPESI.234 | |
| p.22 | IIb | C | In patients without haemodynamic instability, use of validated scores combining clinical, imaging, and laboratory PE-related prognostic factors may be considered to further stratify the severity of the acute PE episode.218223 | |
| p.26 | I | B | Systemic thrombolytic therapy is recommended for high-risk PE. 282 | |
| p.26 | I | C | It is recommended that anticoagulation with UFH, including a weight-adjusted bolus injection, be initiated without delay in patients with high-risk PE. | |
| p.26 | I | C | Surgical pulmonary embolectomy is recom- mended for patients with high-risk PE, in whom thrombolysis is contraindicated or has failed.d 281 | |
| p.26 | IIa | C | Percutaneous catheter-directed treatment should be considered for patients with high- risk PE, in whom thrombolysis is contraindicated or has failed.d | |
| p.26 | IIa | C | Norepinephrine and/or dobutamine should be considered in patients with high-risk PE. | |
| p.26 | IIb | C | ECMO may be considered, in combination with surgical embolectomy or catheter-directed treat- ment, in patients with PE and refractory circula- tory collapse or cardiac arrest.d 252 | |
| p.27 | III | A | Routine use of IVC filters is not recommended.302304 | |
| p.27 | I | C | Initiation of anticoagulation Initiation of anticoagulation is recommended without delay in patients with high or inter- mediate clinical probability of PE,c while diag- nostic workup is in progress. | |
| p.27 | I | A | If anticoagulation is initiated parenterally, LMWH or fondaparinux is recommended (over UFH) for most patients.262,309311 | |
| p.27 | I | A | When oral anticoagulation is started in a patient with PE who is eligible for a NOAC (apixaban, dabigatran, edoxaban, or rivaroxa- ban), a NOAC is recommended in preference to a VKA.260,261,312314 | |
| p.27 | I | A | When patients are treated with a VKA, over- lapping with parenteral anticoagulation is rec- ommended until an INR of 2.5 (range 2.03.0) is reached.315,316 | |
| p.27 | III | C | NOACs are not recommended in patients with severe renal impairment,d during pregnancy and lactation, and in patients with antiphospholipid antibody syndrome.260,261,312314 | |
| p.27 | I | B | Reperfusion treatment Rescue thrombolytic therapy is recommended for patients with haemodynamic deterioration on anticoagulation treatment.282 | |
| p.27 | IIa | C | As an alternative to rescue thrombolytic ther- apy, surgical embolectomye or percutaneous catheter-directed treatmente should be con- sidered for patients with haemodynamic dete- rioration on anticoagulation treatment. | |
| p.27 | III | B | Routine use of primary systemic thrombolysis is not recommended in patients with inter- mediate- or low-risk PE.c,f 179 | |
| p.27 | IIa | C | Set-up of a multidisciplinary team and a pro- gramme for the management of high- and (in selected cases) intermediate-risk PE should be considered, depending on the resources and expertise available in each hospital. PE = pulmonary embolism. aClass of recommendation. bLevel of evidence. | |
| p.27 | IIa | C | IVC filters should be considered in patients with acute PE and absolute contraindications to anticoagulation. | |
| p.27 | IIa | C | IVC filters should be considered in cases of PE recurrence despite therapeutic anticoagulation. IVC = inferior vena cava; PE = pulmonary embolism. aClass of recommendation. bLevel of evidence. | |
| p.27 | IIa | A | Carefully selected patients with low-risk PE should be considered for early discharge and continuation of treatment at home, if proper outpatient care and anticoagulant treatment can be provided.c 178,206,317319 | |
| p.35 | I | A | Therapeutic anticoagulation for >_ 3 months is recommended for all patients with PE.347 | |
| p.35 | I | B | For patients with first PE/VTE secondary to a major transient/reversible risk factor, discontinuation of therapeutic oral anticoagulation is recommended after 3 months.331,340,341 | |
| p.35 | I | B | with at least one previous episode of PE or DVT) not related to a major transient or reversible risk factor.358 | |
| p.35 | I | B | body syndrome.359 | |
| p.35 | IIa | A | Extended oral anticoagulation of indefinite duration should be considered for patients with a first episode of PE and no identifiable risk factor.330,331,347,351353 | |
| p.35 | IIa | C | with a persistent risk factor other than antiphospholipid antibody syndrome.330,352,353 | |
| p.35 | IIa | C | Extended oral anticoagulation of indefinite duration should be considered for patients with a first episode of PE associated with a minor transient or reversible risk factor.330,331,352 | |
| p.35 | IIa | A | (2.5 mg b.i.d.) or rivaroxaban (10 mg o.d.) should be considered after 6 months of therapeutic anticoagulation.352,353 | |
| p.35 | IIb | B | sidered for extended VTE prophylaxis.355357 | |
| p.35 | I | C | In patients who receive extended anticoagulation, it is recommended that their drug tolerance and adherence, hepatic and renalf function, and bleeding risk be reassessed at regular intervals.259 | |
| p.37 | IIa | A | VKAs.360363 | |
| p.37 | IIa | B | tinal cancer.366 | |
| p.37 | IIa | C | testinal cancer.367 | |
| p.37 | IIa | B | inite period or until the cancer is cured.378 | |
| p.40 | I | B | Diagnosis Formal diagnostic assessment with validated methods is recommended if PE is suspected dur- ing pregnancy or in the post-partum period.388,391 | |
| p.40 | IIa | B | D-dimer measurement and clinical prediction rules should be considered to rule out PE during pregnancy or the post-partum period.388,391 | |
| p.40 | IIa | B | In a pregnant patient with suspected PE (par- ticularly if she has symptoms of DVT), venous CUS should be considered to avoid unneces- sary irradiation.388 | |
| p.40 | IIa | C | Perfusion scintigraphy or CTPA (with a low-radi- ation dose protocol) should be considered to rule out suspected PE in pregnant women; CTPA should be considered as the first-line option if the chest X-ray is abnormal.385,386 | |
| p.40 | I | B | Treatment A therapeutic, fixed dose of LMWH based on early pregnancy body weight is the recom- mended therapy for PE in the majority of pregnant women without haemodynamic instability.408,410 | |
| p.40 | IIa | C | Thrombolysis or surgical embolectomy should be considered for pregnant women with high- risk PE.421 | |
| p.40 | III | C | Insertion of a spinal or epidural needle is not rec- ommended, unless >_24 h have passed since the last therapeutic dose of LMWH. | |
| p.40 | III | C | Administration of LMWH is not recom- mended within 4 h of removal of an epidural catheter. | |
| p.40 | III | C | NOACs are not recommended during preg- nancy or lactation. Amniotic fluid embolism | |
| p.40 | IIa | C | Amniotic fluid embolism should be considered in a pregnant or post-partum woman with otherwise unexplained cardiac arrest, sus- tained hypotension, or respiratory deterioration, especially if accompanied by disseminated intravascular coagulation.422,425,426 ............ | |
| p.45 | I | B | Routine clinical evaluationc of patients 36 months after the acute PE episode is recommended.288,352,353,437 | |
| p.45 | I | C | An integrated model of patient care after PE (involving hospital specialists, appropriately qualified nurses, and primary care physicians) is recommended to ensure optimal transition from hospital to community care. | |
| p.45 | I | C | In symptomatic patients with mismatched perfusion defects persisting on V/Q scand beyond 3 months after acute PE, referral to a PH/ CTEPH expert centre is recommended, after taking into account the results of echocardiog- raphy, natriuretic peptide levels, and/or | |
| p.45 | IIa | C | CPET.477 Further diagnostic evaluatione should be con- sidered in patients with persistent or new- onset dyspnoea/exercise limitation after PE. | |
| p.45 | IIb | C | Further diagnostic evaluatione may be considered in asymptomatic patients with risk factors for CTEPH.f 447449,478 |