p.3 抽出テキスト

............................................................................................................................................................ 6.1.2 Pharmacological treatment of acute right ventricular failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 564 6.1.3 Mechanical circulatory support and oxygenation . . . . . . . . . 565 6.1.4 Advanced life support in cardiac arrest . . . . . . . . . . . . . . . . . . 565 6.2 Initial anticoagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565 6.2.1 Parenteral anticoagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565 6.2.2 Non-vitamin K antagonist oral anticoagulants . . . . . . . . . . . . 566 6.2.3 Vitamin K antagonists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 6.3 Reperfusion treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 6.3.1 Systemic thrombolysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 6.3.2 Percutaneous catheter-directed treatment . . . . . . . . . . . . . . 567 6.3.3 Surgical embolectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 567 6.4 Multidisciplinary pulmonary embolism teams . . . . . . . . . . . . . . . . 568 6.5 Vena cava filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 568 7 Integrated risk-adapted diagnosis and management . . . . . . . . . . . . . . . 570 7.1 Diagnostic strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 570 7.1.1 Suspected pulmonary embolism with haemodynamic instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 571 7.1.2 Suspected pulmonary embolism without haemodynamic instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572

7.1.2.1 Strategy based on computed tomographic pulmonary angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572 7.1.2.2 Strategy based on ventilation/perfusion scintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572 7.2 Treatment strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572 7.2.1 Emergency treatment of high-risk pulmonary embolism . . 572 7.2.2 Treatment of intermediate-risk pulmonary embolism . . . . 572 7.2.3 Management of low-risk pulmonary embolism: triage for early discharge and home treatment . . . . . . . . . . . . . . . . . . . . . . 572 8 Chronic treatment and prevention of recurrence . . . . . . . . . . . . . . . . 574 8.1 Assessment of venous thromboembolism recurrence risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575 8.2 Anticoagulant-related bleeding risk . . . . . . . . . . . . . . . . . . . . . . . . . . 576 8.3 Regimens and treatment durations with non-vitamin K antagonist oral anticoagulants, and with other non-vitamin K antagonist antithrombotic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 576 8.5 Management of pulmonary embolism in patients with cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578 9 Pulmonary embolism and pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579 9.1 Epidemiology and risk factors for pulmonary embolism in pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579 9.2 Diagnosis of pulmonary embolism in pregnancy . . . . . . . . . . . . . . 579 9.2.1 Clinical prediction rules and D-dimers . . . . . . . . . . . . . . . . . . . 579 9.2.2 Imaging tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579 9.3 Treatment of pulmonary embolism in pregnancy . . . . . . . . . . . . . 581 9.3.1 Role of a multidisciplinary pregnancy heart team . . . . . . . . . 582 9.4 Amniotic fluid embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 582 10 Long-term sequelae of pulmonary embolism . . . . . . . . . . . . . . . . . . . . 583 10.1 Persisting symptoms and functional limitation after pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 583 10.2 Chronic thromboembolic pulmonary hypertension . . . . . . . . . 583 10.2.1 Epidemiology, pathophysiology, and natural history . . . . . 583 10.2.2 Clinical presentation and diagnosis . . . . . . . . . . . . . . . . . . . . . 584 10.2.3 Surgical treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 584 10.2.4 Balloon pulmonary angioplasty . . . . . . . . . . . . . . . . . . . . . . . . 585 10.2.5 Pharmacological treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585 10.3 Strategies for patient follow-up after pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 586 11 Non-thrombotic pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . 587 12 Key messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587 13 Gaps in the evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 588 14 ‘What to do’ and ‘what not to do’ messages from the Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 589 15 Supplementary data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 590 16 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 590 17 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 591

Recommendations

4.11 Recommendations for diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 559 5.7 Recommendations for prognostic assessment . . . . . . . . . . . . . . . . . . 564 6.6 Recommendations for acute-phase treatment of high-risk pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 568 6.7 Recommendations for acute-phase treatment of intermediateor low-risk pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569 6.8 Recommendations for multidisciplinary pulmonary embolism teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569 6.9 Recommendations for inferior vena cava filters . . . . . . . . . . . . . . . . . 569 6.10 Recommendations for early discharge and home treatment . . . . 569 8.4 Recommendations for the regimen and the duration of anticoagulation after pulmonary embolism in patients without cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577 8.6 Recommendations for the regimen and the duration of anticoagulation after pulmonary embolism in patients with active cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579 9.5 Recommendations for pulmonary embolism in pregnancy . . . . . . 582 10.4 Recommendations for follow-up after acute pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587

List of tables

Table 1 Classes of recommendation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 548 Table 2 Levels of evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 548 Table 3 Predisposing factors for venous thromboembolism . . . . . . . . 552 Table 4 Definition of haemodynamic instability, which delineates acute high-risk pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 553 Table 5 The revised Geneva clinical prediction rule for pulmonary embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 554 Table 6 Imaging tests for diagnosis of pulmonary embolism . . . . . . . . . 556 Table 7 Original and simplified Pulmonary Embolism Severity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 Table 8 Classification of pulmonary embolism severity and the risk of early (in-hospital or 30-day) death . . . . . . . . . . . . . . . . . . . . . . . . . . 563 Downloaded from academic.oup.com/eurheartj/article/41/4/543/5556136 by guest on 07 October 2026