Consenso multidisciplinar para el manejo de la tromboembolia de pulmón |
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Institution: | 1. Servicio de Neumología, Hospital Universitario Araba/Universidad del País Vasco, Vitoria, España;2. CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España;3. Servicio de Radiología, Hospital Doce de Octubre, Madrid, España;4. Servicio de Radiología, Hospital Universitario de Alicante, Alicante, España;5. Servicio de Hematología, Hospital Universitario de Bellvitge, Barcelona, España;6. Servicio de Cardiología, Hospital Doce de Octubre, Madrid, España;7. Servicio de Medicina Interna, Hospital La Paz/Universidad Autónoma, Madrid, España;8. Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España;9. Servicio de Urgencias, Hospital Clinic, IDIBAPS, Barcelona, España;10. Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España;11. Servicio de Hematología, Clínica Universidad de Navarra/IdISNA, Navarra, España;12. Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona, España;13. Servicio de Medicina Interna, Clínica Universidad de Navarra/Interdisciplinar Teragnosis and Radiosomics Research Group (INTRA-Madrid), Universidad de Navarra, Navarra, España;14. Servicio de Neumología, Hospital Ramón y Cajal (IRYCIS)/Universidad de Alcalá, Madrid, España |
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Abstract: | 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. |
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Keywords: | Pulmonary embolism Diagnosis Prognosis Treatment |
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