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2019 ESC Guidelines on Acute Pulmonary Embolism

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La Dra. Silvia Valbuena López apunta las novedades incluidas en el documento presentado en ESC Congress 2019.

Published in: Health & Medicine
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2019 ESC Guidelines on Acute Pulmonary Embolism

  1. 1. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE European Heart Journal, ehz405, https://doi.org/10.1093/eurheartj/ehz405
  2. 2. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE What´s new in the 2019 Guidelines? Diagnostic algorithm and role of diagnostic tests Acute phase treatment Chronic anticoagulation Long term care/CTEPH Pregnancy
  3. 3. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE DIAGNOSIS. Unstable patient algorithm No clinical probability assessment No D-dimer
  4. 4. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE DIAGNOSIS. Stable patient algorithm No changes compared to 2014 If high probability  CTPA
  5. 5. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE DIAGNOSIS
  6. 6. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE RISK ASSESSMENT • If not high risk use validated clinical prediction rules (PESI) for further stratification • RV imaging and biomarkers should be performed despite low PESI
  7. 7. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE ACUTE PHASE TREATMENT High risk Intermediate-low risk
  8. 8. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE CHRONIC PHASE TREATMENT. Duration ALWAYS at least 3 months Tailored duration of OAC depending on recurrence risk No unprovoked PE!!!
  9. 9. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE CHRONIC PHASE TREATMENT. Duration
  10. 10. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE CHRONIC PHASE TREATMENT. Cancer Indefinite treatment LMWH, edoxaban or rivaroxaban Indicación clase IIa
  11. 11. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE PREGNANCY  First evidence of tailored diagnostic algorithm tested prospectively (2 studies)  D-dimer use now recommended  Objective  safely exclude PE reducing imaging test (radiation exposure)
  12. 12. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE PREGNANCY
  13. 13. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE PREGNANCY
  14. 14. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE Screening??? Not for everybody! Risk factors for CTEPH LONG-TERM FOLLOW-UP. CTEPH
  15. 15. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE LONG-TERM FOLLOW-P. CTEPH
  16. 16. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE CONCLUSIONES El embarazo finalmente recibe atención NOAC primera línea de tratamiento Novedades en diagnóstico y tratamiento agudo Factores de riesgo de CTEPH en pacientes sin disnea
  17. 17. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE • Cambio de paradigma en el uso de fármacos hipoglucemiantes  peso de la nueva evidencia científica • Nueva clasificación del riesgo CV • Intervención sobre el estilo de vida y aproximación multifactorial sobre el riesgo cardiovascular • Nuevos objetivos de TA y LDL • Modificaciones en las recomendaciones en terapia antitrombótica CONCLUSIONES

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