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The 2019 European guidelines on pulmonary embolism illustrated with the aid of an exemplary case report
BACKGROUND: 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 manag...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873787/ https://www.ncbi.nlm.nih.gov/pubmed/33598618 http://dx.doi.org/10.1093/ehjcr/ytaa542 |
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author | Gallo, Andrea Valerio, Luca Barco, Stefano |
author_facet | Gallo, Andrea Valerio, Luca Barco, Stefano |
author_sort | Gallo, Andrea |
collection | PubMed |
description | BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: 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. |
format | Online Article Text |
id | pubmed-7873787 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-78737872021-02-16 The 2019 European guidelines on pulmonary embolism illustrated with the aid of an exemplary case report Gallo, Andrea Valerio, Luca Barco, Stefano Eur Heart J Case Rep Classic Case Report BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: 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. Oxford University Press 2021-01-04 /pmc/articles/PMC7873787/ /pubmed/33598618 http://dx.doi.org/10.1093/ehjcr/ytaa542 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Classic Case Report Gallo, Andrea Valerio, Luca Barco, Stefano The 2019 European guidelines on pulmonary embolism illustrated with the aid of an exemplary case report |
title | The 2019 European guidelines on pulmonary embolism illustrated with the aid of an exemplary case report |
title_full | The 2019 European guidelines on pulmonary embolism illustrated with the aid of an exemplary case report |
title_fullStr | The 2019 European guidelines on pulmonary embolism illustrated with the aid of an exemplary case report |
title_full_unstemmed | The 2019 European guidelines on pulmonary embolism illustrated with the aid of an exemplary case report |
title_short | The 2019 European guidelines on pulmonary embolism illustrated with the aid of an exemplary case report |
title_sort | 2019 european guidelines on pulmonary embolism illustrated with the aid of an exemplary case report |
topic | Classic Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873787/ https://www.ncbi.nlm.nih.gov/pubmed/33598618 http://dx.doi.org/10.1093/ehjcr/ytaa542 |
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