Lobo José Luis, Alonso Sergio, Arenas Juan, Domènech Pere, Escribano Pilar, Fernández-Capitán Carmen, Jara-Palomares Luis, Jiménez Sonia, Lázaro María, Lecumberri Ramón, Monreal Manuel, Ruiz-Artacho Pedro, Jiménez David
Servicio de Neumología, Hospital Universitario Araba/Universidad del País Vasco, Vitoria, España; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
Servicio de Radiología, Hospital Doce de Octubre, Madrid, España.
Arch Bronconeumol. 2022 Mar;58(3):246-254. doi: 10.1016/j.arbres.2021.01.031. Epub 2021 Feb 13.
We have updated recommendations on 12 controversial topics that were published in the 2013 National Consensus on the diagnosis, risk stratification and treatment of patients with pulmonary embolism (PE). A comprehensive review of the literature was performed for each topic, and each recommendation was evaluated in two teleconferences. For diagnosis, we recommend against using the Pulmonary Embolism Rule Out Criteria (PERC) rule as the only test to rule out PE, and we recommend using a D-dimer cutoff adjusted to age to rule out PE. We suggest using computed tomography pulmonary angiogram as the imaging test of choice for the majority of patients with suspected PE. We recommend using direct oral anticoagulants (over vitamin K antagonists) for the vast majority of patients with acute PE, and we suggest using anticoagulation for patients with isolated subsegmental PE. We recommend against inserting an inferior cava filter for the majority of patients with PE, and we recommend using full-dose systemic thrombolytic therapy for PE patients requiring reperfusion. The decision to stop anticoagulants at 3 months or to treat indefinitely mainly depends on the presence (or absence) and type of risk factor for venous thromboembolism, and we recommend against thrombophilia testing to decide duration of anticoagulation. Finally, we suggest against extensive screening for occult cancer in patients with PE.
我们已更新了关于12个有争议主题的建议，这些主题发表于2013年《肺栓塞（PE）患者诊断、风险分层及治疗的全国共识》。针对每个主题进行了全面的文献综述，并在两次电话会议中对每项建议进行了评估。对于诊断，我们不建议将肺栓塞排除标准（PERC）规则作为排除PE的唯一检查，建议使用根据年龄调整的D-二聚体临界值来排除PE。我们建议将计算机断层扫描肺动脉造影作为大多数疑似PE患者的首选影像学检查。对于绝大多数急性PE患者，我们建议使用直接口服抗凝药（而非维生素K拮抗剂），对于孤立性亚段PE患者，我们建议进行抗凝治疗。对于大多数PE患者，我们不建议置入下腔静脉滤器，对于需要再灌注的PE患者，我们建议使用全剂量全身溶栓治疗。在3个月时停用抗凝药还是无限期治疗的决定主要取决于静脉血栓栓塞危险因素的存在（或不存在）及类型，我们不建议通过血栓形成倾向检测来决定抗凝持续时间。最后，我们不建议对PE患者进行广泛的隐匿性癌症筛查。
