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| {{main|Warfarin}} | | {{main|Warfarin}} |
| * The recommended therapeutic INR on warfarin is 2.0-3.0. | | * The recommended therapeutic INR on warfarin is 2.0-3.0. |
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| == ESC Guidelines treatment High-risk pulmonary embolism (DO NOT EDIT)==
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| <ref name="pmid18757870">{{cite journal |author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP |title=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) |journal=Eur. Heart J. |volume=29|issue=18 |pages=2276–315 |year=2008 |month=September |pmid=18757870 |doi=10.1093/eurheartj/ehn310|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18757870 |accessdate=2011-12-07}}</ref>
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| {{cquote|
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| ===[[European society of cardiology#Classes of Recommendations|Class I]]===
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| '''1.''' Anticoagulation with unfractionated heparin should be initiated without delay in patients with high-risk PE. ''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])''
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| '''2.''' Systemic hypotension should be corrected to prevent progression of RV failure and death due to PE. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
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| '''3.''' Vasopressive drugs are recommended for hypotensive patients with PE. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
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| ===[[European society of cardiology#Classes of Recommendations|Class IIa]]===
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| '''4.''' Dobutamine and dopamine may be used in patients with PE, low cardiac output and normal blood pressure. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
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| ===[[European society of cardiology#Classes of Recommendations|Class III]]===
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| '''5.''' Aggressive fluid challenge is not recommended. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
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| ===[[European society of cardiology#Classes of Recommendations|Class I]]===
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| '''6.''' Oxygen should be administered in patients with hypoxaemia.''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
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| '''7.''' Thrombolytic therapy should be used in patients with high-risk PE presenting with cardiogenic shock and/or persistent arterial hypotension.''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])''
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| '''8.''' Surgical pulmonary embolectomy is a recommended therapeutic alternative in patients with high-risk PE in whom thrombolysis
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| is absolutely contraindicated or has failed.''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
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| ===[[European society of cardiology#Classes of Recommendations|Class IIb]]===
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| '''9.'''Catheter embolectomy or fragmentation of proximal pulmonary arterial clots may be considered as an alternative to surgical treatment in high-risk patients when thrombolysis is absolutely contraindicated or has failed. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
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| }}
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| ==ESC Guidelines treatment Non-high-risk pulmonary embolism (DO NOT EDIT)==
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| <ref name="pmid18757870">{{cite journal |author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP |title=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) |journal=Eur. Heart J. |volume=29|issue=18 |pages=2276–315 |year=2008 |month=September |pmid=18757870 |doi=10.1093/eurheartj/ehn310|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18757870 |accessdate=2011-12-07}}</ref>
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| {{cquote|
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| ===[[European society of cardiology#Classes of Recommendations|Class I]]===
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| '''1.''' Anticoagulation should be initiated without delay in patients with high or intermediate clinical probability of PE while diagnostic workup is still ongoing. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
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| '''2.''' Use of LMWH or fondaparinux is the recommended form of initial treatment for most patients with non-high-risk PE. ''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])''
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| '''3.''' In patients at high risk of bleeding and in those with severe renal dysfunction, unfractionated heparin with an aPTT target range of 1.5–2.5 times normal is a recommended form of initial treatment. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
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| '''4.''' Initial treatment with unfractionated heparin, LMWH or fondaparinux should be continued for at least 5 days and ''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])'' may be replaced by vitamin K antagonists only after achieving target INR levels for at least 2 consecutive days ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
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| ===[[European society of cardiology#Classes of Recommendations|Class IIb]]===
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| '''5.''' Routine use of thrombolysis in non–high-risk PE patients is not recommended, but it may be considered in selected patients
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| with intermediate-risk PE ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
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| ===[[European society of cardiology#Classes of Recommendations|Class III]]===
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| '''6.''' Thrombolytic therapy should be not used in patients with low-risk PE ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
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| }}
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| ==ESC Guidelines Recommendations Long-term treatment (DO NOT EDIT)==
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| <ref name="pmid18757870">{{cite journal |author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP |title=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) |journal=Eur. Heart J. |volume=29|issue=18 |pages=2276–315 |year=2008 |month=September |pmid=18757870 |doi=10.1093/eurheartj/ehn310|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18757870 |accessdate=2011-12-07}}</ref>
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| {{cquote|
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| ===[[European society of cardiology#Classes of Recommendations|Class I]]===
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| '''1.''' For patients with PE secondary to a transient (reversible) risk factor, treatment with a VKA is recommended for 3 months.''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])''
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| '''2.''' For patients with unprovoked PE, treatment with a VKA is recommended for at least 3 months. ''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])''
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| '''3.''' For patients with a second episode of unprovoked PE, long-term treatment is recommended. ''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])''
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| '''4.''' In patients who receive long-term anticoagulant treatment, the risk/benefit ratio of continuing such treatment should be reassessed at regular intervals. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''
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| '''5.''' In patients with PE, the dose of VKA should be adjusted to maintain a target INR of 2.5 (range 2.0–3.0) regardless of treatment duration. ''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])''
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| ===[[European society of cardiology#Classes of Recommendations|Class IIb]]===
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| '''6.''' Patients with a first episode of unprovoked PE and low risk of bleeding, and in whom stable anticoagulation can be achieved, may be considered for long-term oral anticoagulation. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''
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| ===[[European society of cardiology#Classes of Recommendations|Class IIa]]===
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| '''7.''' For patients with PE and cancer, LMWH should be considered for the first 3–6 months ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])'' after this period, anticoagulant therapy with VKA or LMWH should be continued indefinitely or until the cancer is considered cured. ''([[European society of cardiology#Classes of Recommendations|Class I]],[[European society of cardiology#Level of Evidence|Level of Evidence: C]])}}''
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| ==Guidelines Resources==
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| *Guidelines on the diagnosis and management of acute pulmonary embolism<ref name="pmid18757870">{{cite journal |author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP |title=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) |journal=Eur. Heart J. |volume=29|issue=18 |pages=2276–315 |year=2008 |month=September |pmid=18757870 |doi=10.1093/eurheartj/ehn310|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18757870 |accessdate=2011-12-07}}</ref>.
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| ==References== | | ==References== |