European Heart Journal Advance Access originally published online on August 30, 2008
European Heart Journal 2008 29(18):2276-2315; doi:10.1093/eurheartj/ehn310
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© The European Society of Cardiology 2008. All rights reserved. For permissions please email: journals.permissions@oxfordjournals.org
Guidelines on the diagnosis and management of acute pulmonary embolism
The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)
Authors/Task Force Members,
(Poland)
(Switzerland)
(Germany)
(Italy)
(Italy)
(Poland)
(USA)
(UK)
(Portugal)
(Germany)
(Austria)
(Germany)
(France)
(France)
Full author affiliations can be found on the page dedicated to these guidelines on the ESC Web Site (www.escardio.org/guidelines)
ESC Committee for Practice Guidelines (CPG),
(France)
(UK)
(Italy)
(France)
(Norway)
(Greece)
(France)
(Netherlands)
(Denmark)
(France)
(Germany)
(Germany)
(Poland)
(Czech Republic)
(Spain)
Document Reviewers,
(Italy)
(Czech Republic)
(Greece)
(Belgium)
(UK)
(Hungary)
(Spain)
(France)
(Denmark)
(Finland)
(Austria)
(The Netherlands)
(Spain)
(UK)
(Spain)
(Germany)
(Italy)
(Belgium)
* Corresponding author. Department of Chest Medicine, Institute for Tuberculosis and Lung Diseases, ul. Plocka 26, 01–138 Warsaw, Poland. Tel: +48 22 431 2114, Fax: +48 22 431 2414; Email: a.torbicki@igichp.edu.pl
Key Words: Pulmonary embolism • Venous thrombosis • Shock • Hypotension • Chest pain • Dyspnoea • Heart failure • Diagnosis • Prognosis • Treatment • Guidelines
List of Abbreviations: aPTT, activated partial thromboplastin time • anti-Xa, anti-factor Xa activity • BNP, brain natriuretic peptide • CI, confidence interval • CT, computed tomography • CTEPH, chronic thromboembolic pulmonary hypertension • CUS, compression venous ultrasonography • DVT, deep vein thrombosis • ECG, electrocardiogram • ELISA, enzyme-linked immunoabsorbent assay • HIT, heparin-induced thrombocytopenia • ICOPER, International Cooperative Pulmonary Embolism Registry • INR, international normalized ratio • IVC, inferior vena cava • LMWH, low molecular weight heparin • LV, left ventricle • MDCT, multidetector computed tomography • NPV, negative predictive value • NT-proBNP, N-terminal proBNP • OR, odds ratio • PaO2, arterial oxygen pressure • PE, pulmonary embolism • PIOPED, Prospective Investigation On Pulmonary Embolism Diagnosis study • PPV, positive predictive value • rtPA, recombinant tissue plasminogen activator • RV, right ventricle • RVD, right ventricular dysfunction • SBP, systolic blood pressure • SDCT, single-detector computed tomography • VKA, vitamin K antagonist • VTE, venous thromboembolism • V/Q scan, ventilation–perfusion scintigraphy
The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC.
Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written. Health professionals are encouraged to take them fully into account when exercising their clinical judgement. The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where
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Preamble |
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Introduction |
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Epidemiology
Predisposing factors
Natural history
Pathophysiology
Severity of pulmonary embolism
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Diagnosis |
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Clinical presentation
Assessment of clinical probability
D-dimer
Compression ultrasonography and computed tomographic venography
Ventilation–perfusion scintigraphy
Computed tomography
Pulmonary angiography
Echocardiography
Diagnostic strategies
Suspected high-risk pulmonary embolism
Suspected non-high-risk pulmonary embolism
Strategy based on computed tomographic angiography
Role of lower limb compression ultrasonography
Role of V/Q scintigraphy
Role of echocardiography
Areas of uncertainty
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Prognostic assessment |
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Clinical assessment of haemodynamic status
Hypotension and shock
Markers of right ventricular dysfunction
Echocardiography
Computed tomography
Brain natriuretic peptide
Other markers of RV dysfunction
Markers of myocardial injury
Cardiac troponins
New markers of myocardial injury
Combination of markers of myocardial injury and RV dysfunction
Additional risk markers
Clinical and routine laboratory tests
Strategy of prognostic assessment
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Treatment |
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Haemodynamic and respiratory support
Thrombolysis
Surgical pulmonary embolectomy
Percutaneous catheter embolectomy and fragmentation
Initial anticoagulation
Therapeutic strategies
High-risk pulmonary embolism
Non-high-risk pulmonary embolism
Long-term anticoagulation and secondary prophylaxis
Venous filters
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Specific problems |
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Pregnancy
Diagnosis of pulmonary embolism in pregnancy
Treatment of pulmonary embolism in pregnancy
Malignancy
Right heart thrombi
Heparin-induced thrombocytopenia
Chronic thromboembolic pulmonary hypertension
Non-thrombotic pulmonary embolism
Septic embolism
Intravascular foreign bodies
Fat embolism
Venous air embolism
Amniotic fluid embolism
Talc embolism
Tumour embolism
Rare causes
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Supplementary material |
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List of acronyms and abbreviations |
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Footnotes |
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References |
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