2023ESC急性肺栓塞诊断和管理指南(英文版)

第第页2023ESC急性肺栓塞诊断和管理指南(英文版)

ESCGUIDELINES2023ESCGuidelinesonthediagnosisand

managementofacutepulmonaryembolism

TheTaskForcefortheDiagnosisandManagementofAcute

PulmonaryEmbolismoftheEuropeanSocietyofCardiology(ESC)EndorsedbytheEuropeanRespiratorySociety(ERS)

Authors/TaskForceMembers:StavrosKonstantinides*(Chairperson)(Germany/Greece),AdamTorbicki*(Co-chairperson)(Poland),GiancarloAgnelli(Italy),NicolasDanchin(France),DavidFitzmaurice(UK),NazzarenoGalie`(Italy),

J.SimonR.Gibbs(UK),MennoHuisman(TheNetherlands),MarcHumbert?(France),NilsKucher(Switzerland),IreneLang(Austria),MareikeLankeit(Germany),JohnLekakis(Greece),ChristophMaack(Germany),EckhardMayer(Germany),

NicolasMeneveau(France),ArnaudPerrier(Switzerland),PiotrPruszczyk(Poland),LarsH.Rasmussen(Denmark),ThomasH.Schindler(USA),PavelSvitil(Czech

Republic),AntonVonkNoordegraaf(TheNetherlands),JoseLuisZamorano(Spain),MaurizioZompatori(Italy)

ESCCommitteeforPracticeGuidelines(CPG):JoseLuisZamorano(Chairperson)(Spain),StephanAchenbach(Germany),HelmutBaumgartner(Germany),JeroenJ.Bax(Netherlands),HectorBueno(Spain),VeronicaDean(France),ChristiDeaton(UK),?etinErol(Turkey),RobertFagard(Belgium),RobertoFerrari(Italy),DavidHasdai(Israel),ArnoHoes(Netherlands),PaulusKirchhof(Germany/UK),JuhaniKnuuti(Finland),PhilippeKolh(Belgium),PatrizioLancellotti(Belgium),AlesLinhart(CzechRepublic),PetrosNihoyannopoulos(UK),MassimoF.

Piepoli*Correspondingauthors.StavrosKonstantinides,CentreforThrombosisandHemostasis,JohannesGutenbergUniversityofMainz,UniversityMedicalCentreMainz,Langenbeckstrasse1,55131Mainz,Germany.Tel:+496131176255,Fax:+496131173456.Email:stavros.konstantinides@unimedizin-mainz.de,andDepartmentofCardiology,DemocritusUniversityofThrace,Greece.Email:skonst@med.duth.gr.

AdamTorbicki,DepartmentofPulmonaryCirculationandThromboembolicDiseases,MedicalCentreofPostgraduateEducation,ECZ-Otwock,Ul.Borowa14/18,05-400Otwock,Poland.Tel:+48227103052,Fax:+4822710315.Email:adam.torbicki@ecz-otwock.pl.

?RepresentingtheEuropeanRespiratorySociety

OtherESCentitieshavingparticipatedinthedevelopmentofthisdocument:

ESCAssociations:AcuteCardiovascularCareAssociation(ACCA),EuropeanAssociationforCardiovascularPreventionhowever,theESCGuidelinesdonotoverride,inanywaywhatsoever,theinpidualresponsibilityofhealthprofessionalstomakeappropriateandaccuratedecisionsinconsiderationofeachpatient’shealthconditionandinconsultationwiththatpatientand,whereappropriateand/ornecessary,thepatient’scaregiver.NordotheESCGuidelinesexempthealthprofessionalsfromtakingintofullandcarefulconsiderationtherelevantof?cialupdatedrecommendationsorguidelinesissuedbythecompetentpublichealthauthorities,inordertomanageeachpatient’scaseinlightofthescienti?callyaccepteddatapursuanttotheirrespectiveethicalandprofessionalobligations.Itisalsothehealthprofessional’sresponsibilitytoverifytheapplicablerulesandregulationsrelatingtodrugsandmedicaldevicesatthetimeofprescription.

NationalCardiacSocietiesdocumentreviewers:listedintheAppendix.

&TheEuropeanSocietyofCardiology2023.Allrightsreserved.Forpermissionspleaseemail:journals.permissions@e43f5da204a1b0717ed5dd2a.EuropeanHeartJournaldoi:10.1093/eurheartj/ehu283

EuropeanHeartJournalAdvanceAccesspublishedAugust29,2023atFujianUniversityofTraditionalChineseMedicineonAugust30,2023e43f5da204a1b0717ed5dd2a/Downloadedfrom

(Italy),PiotrPonikowski(Poland),PerAntonSirnes(Norway),JuanLuisTamargo(Spain),MichalTendera(Poland),AdamTorbicki(Poland),WilliamWijns(Belgium),StephanWindecker(Switzerland).

DocumentReviewers:?etinErol(CPGReviewCoordinator)(Turkey),DavidJimenez(ReviewCoordinator)(Spain),WalterAgeno(Italy),StefanAgewall(Norway),RiccardoAsteggiano(Italy),RupertBauersachs(Germany),

CeciliaBecattini(Italy),HenriBounameaux(Switzerland),HarryR.Bu¨ller(Netherlands),ConstantinosH.Davos(Greece),ChristiDeaton(UK),Geert-JanGeersing(Netherlands),MiguelAngelGo′mezSanchez(Spain),

JeroenHendriks(Netherlands),ArnoHoes(Netherlands),MustafaKilickap(Turkey),ViacheslavMareev(Russia),ManuelMonreal(Spain),JoaoMorais(Portugal),PetrosNihoyannopoulos(UK),BogdanA.Popescu(Romania),OlivierSanchez?(France),AlexC.Spyropoulos(USA).

ThedisclosureformsprovidedbytheexpertsinvolvedinthedevelopmentoftheseguidelinesareavailableontheESCwebsitee43f5da204a1b0717ed5dd2a/guidelines.

KeywordsGuidelines?Pulmonaryembolism?Venousthrombosis?Shock?Hypotension?Chestpain?Dyspnoea?Heartfailure?Diagnosis?Treatment–Anticoagulation?Thrombolysis

TableofContents

Abbreviationsandacronyms(3)

1.Preamble(3)

2.Introduction(4)

2.1Epidemiology(5)

2.2Predisposingfactors(5)

2.3Naturalhistory(6)

2.4Pathophysiology(6)

2.5Clinicalclassi?cationofpulmonaryembolismseverity(7)

3.Diagnosis(7)

3.1Clinicalpresentation(7)

3.2Assessmentofclinicalprobability(8)

3.3D-dimertesting(8)

3.4Computedtomographicpulmonaryangiography(10)

3.5Lungscintigraphy(11)

3.6Pulmonaryangiography(11)

3.7Magneticresonanceangiography(11)

3.8Echocardiography(11)

3.9Compressionvenousultrasonography(12)

3.10.Diagnosticstrategies(12)

3.10.1Suspectedpulmonaryembolismwithshock

orhypotension(12)

3.10.2Suspectedpulmonaryembolismwithout

shockorhypotension(13)

3.11.Areasofuncertainty(14)

4.Prognosticassessment(15)

4.1Clinicalparameters(15)

4.2Imagingoftherightventriclebyechocardiography

orcomputedtomographicangiography(16)

4.3Laboratorytestsandbiomarkers(17)

4.3.1Markersofrightventriculardysfunction(17)

4.3.2Markersofmyocardialinjury(17)

4.3.3Other(non-cardiac)laboratorybiomarkers(18)

4.4Combinedmodalitiesandscores(19)

4.5Prognosticassessmentstrategy(19)

5.Treatmentintheacutephase(20)

5.1Haemodynamicandrespiratorysupport(20)

5.2Anticoagulation(20)

5.2.1Parenteralanticoagulation(20)

5.2.2VitaminKantagonists(21)

5.2.3Neworalanticoagulants(22)

5.3Thrombolytictreatment(23)

5.4Surgicalembolectomy(24)

5.5Percutaneouscatheter-directedtreatment(24)

5.6Venous?lters(24)

5.7Earlydischargeandhometreatment(25)

5.8Therapeuticstrategies(26)

5.8.1Pulmonaryembolismwithshockorhypotension

(high-riskpulmonaryembolism)(26)

5.8.2Pulmonaryembolismwithoutshockorhypotension

(intermediate-orlow-riskpulmonaryembolism)(26)

5.9Areasofuncertainty(27)

6.Durationofanticoagulation(29)

6.1Neworalanticoagulantsforextendedtreatment(30)

7.Chronicthromboembolicpulmonaryhypertension(31)

7.1Epidemiology(31)

7.2Pathophysiology(31)

7.3Clinicalpresentationanddiagnosis(31)

7.4Treatmentandprognosis(32)

8.Speci?cproblems(34)

8.1Pregnancy(34)

8.1.1Diagnosisofpulmonaryembolisminpregnancy(34)

8.1.2Treatmentofpulmonaryembolisminpregnancy(34)

8.2Pulmonaryembolismandcancer(35)

8.2.1Diagnosisofpulmonaryembolisminpatientswith

cancer(35)

8.2.2Prognosisforpulmonaryembolisminpatientswith

cancer(35)

8.2.3Managementofpulmonaryembolisminpatientswith

cancer(35)

8.2.4Occultcancerpresentingasunprovoke