2019 ESC Guidelines on Acute Pulmonary Embolism

2019 ESC Guidelines on Acute Pulmonary Embolism

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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE European Heart Journal, ehz405, https://doi.org/10.1093/eurheartj/ehz405
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  Silvia Valbuena LópezESCGUIDELINES 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
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE DIAGNOSIS. Unstable patient algorithm No clinical probability assessment No D-dimer
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE DIAGNOSIS. Stable patient algorithm No changes compared to 2014 If high probability  CTPA
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE DIAGNOSIS
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  Silvia Valbuena LópezESCGUIDELINES 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
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE ACUTE PHASE TREATMENT High risk Intermediate-low risk
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE CHRONIC PHASE TREATMENT. Duration ALWAYS at least 3 months Tailored duration of OAC depending on recurrence risk No unprovoked PE!!!
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE CHRONIC PHASE TREATMENT. Duration
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE CHRONIC PHASE TREATMENT. Cancer Indefinite treatment LMWH, edoxaban or rivaroxaban Indicación clase IIa
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  Silvia Valbuena LópezESCGUIDELINES 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)
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE PREGNANCY
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE PREGNANCY
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE Screening??? Not for everybody! Risk factors for CTEPH LONG-TERM FOLLOW-UP. CTEPH
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  Silvia Valbuena LópezESCGUIDELINES ON ACUTE PE LONG-TERM FOLLOW-P. CTEPH
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  Silvia Valbuena LópezESCGUIDELINES 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
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  Silvia Valbuena LópezESCGUIDELINES 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