Gallo Andrea, Valerio Luca, Barco Stefano
Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Langenbeckstraße 1, Building 403, Room 117, 55131 Mainz, Germany.
Eur Heart J Case Rep. 2021 Jan 4;5(2):ytaa542. doi: 10.1093/ehjcr/ytaa542. eCollection 2021 Feb.
The European Society of Cardiology guidelines for the diagnosis and management of acute pulmonary embolism (PE) developed in collaboration with the European Respiratory Society (ERS) has been updated in 2019. Recommendations were added or updated on all stages of the evaluation and management of pulmonary embolism, encompassing diagnosis, early treatment, and long-term management.
We illustrate an exemplary case, assembled for the purposes of this review, of a 70-year-old woman who presented at the emergency department with dyspnoea and thoracic pain. She was diagnosed with intermediate-high-risk acute PE and promptly treated with low molecular weight heparin. After 24 h of stay in intensive care unit, she was transferred to the cardiology department and switched to non-vitamin K-dependent oral anticoagulant apixaban 10 mg b.i.d. for 7 days and then 5 mg b.i.d. After discharge from the hospital 8 days later, she received standard-dose apixaban 5 mg b.i.d. for 6 months; the dose was reduced to 2.5 mg b.i.d. for long-term secondary prevention. During follow-up, investigations for PE sequelae were performed due to persisting dyspnoea.
This exemplary case report puts into context the main novel recommendations from the 2019 ESC Guidelines, including the combination of clinical (pre-test) probability and adjusted D-dimer cut-offs for diagnosis of acute PE, the key role of right ventricular dysfunction in risk stratification, the choice and dosage of oral anticoagulant agents in early and extended anticoagulation, and the identification and management of chronic sequelae in the long-term follow-up.
欧洲心脏病学会与欧洲呼吸学会合作制定的急性肺栓塞（PE）诊断和管理指南于2019年进行了更新。在肺栓塞评估和管理的各个阶段都增加或更新了建议，包括诊断、早期治疗和长期管理。
我们展示了一个为本综述汇编的典型病例，一名70岁女性因呼吸困难和胸痛就诊于急诊科。她被诊断为中高危急性肺栓塞，并立即接受低分子量肝素治疗。在重症监护病房住院24小时后，她被转至心内科，改用非维生素K依赖的口服抗凝药阿哌沙班，10mg，每日两次，共7天，然后5mg，每日两次。8天后出院，她接受标准剂量阿哌沙班5mg，每日两次，共6个月；剂量减至2.5mg，每日两次用于长期二级预防。随访期间，因持续呼吸困难对肺栓塞后遗症进行了检查。
本典型病例报告结合了2019年ESC指南的主要新建议，包括临床（预测试）概率和调整后的D-二聚体临界值用于诊断急性肺栓塞、右心室功能障碍在风险分层中的关键作用、口服抗凝剂在早期和延长抗凝中的选择和剂量，以及长期随访中慢性后遗症的识别和管理。
