Osteresch R, Fach A, Hambrecht R, Wienbergen H
Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Stiftung Bremer Herzen, Senator-Weßling-Str. 1, 28277, Bremen, Deutschland.
Herz. 2019 Dec;44(8):696-700. doi: 10.1007/s00059-019-04863-5.
This article on the new European Society of Cardiology (ESC) guidelines for diagnostics and management of acute pulmonary embolism (PE) focusses on new or changed recommendations compared to the previous version of the guidelines from 2014. The current risk-adjusted management algorithm for acute PE includes the clinical severity, aggravating comorbid conditions and right ventricular dysfunction. For low-risk patients early discharge and outpatient treatment are possible, whereas for high-risk patients reperfusion treatment and hemodynamic support have to be considered, depending on the hemodynamic situation and contraindications in the individual patient. Effective therapeutic anticoagulation for at least 3 months is recommended for all patients with PE. Potential indicators for extended anticoagulation are given in the guidelines (class I or class IIa recommendations). New oral anticoagulants (NOAC) are the first choice for anticoagulation in preference to vitamin K antagonists (VKA); however, they are not recommended in patients with severe renal dysfunction, during pregnancy or lactation and in patients with antiphospholipid antibody syndrome. Furthermore, a new algorithm for the follow-up after acute PE is proposed in the guidelines. In cases of symptomatic persistent pulmonary hypertension (PH) the transfer to a specialized center is recommended.
本文聚焦于欧洲心脏病学会（ESC）关于急性肺栓塞（PE）诊断与管理的新指南，重点阐述相较于2014年上一版指南中新增或变化的推荐内容。当前急性PE的风险调整管理算法涵盖临床严重程度、加重的合并症以及右心室功能障碍。对于低风险患者，早期出院及门诊治疗是可行的；而对于高风险患者，则需根据个体患者的血流动力学状况和禁忌证，考虑再灌注治疗及血流动力学支持。所有PE患者均建议进行至少3个月的有效治疗性抗凝。指南中给出了延长抗凝的潜在指标（I类或IIa类推荐）。新型口服抗凝药（NOAC）是抗凝的首选，优于维生素K拮抗剂（VKA）；然而，严重肾功能不全患者、妊娠或哺乳期患者以及抗磷脂抗体综合征患者不推荐使用。此外，指南中还提出了急性PE后随访的新算法。对于有症状的持续性肺动脉高压（PH）患者，建议转诊至专科中心。
