2019ESC Guidelines for the diagnosisand

AAA INT ACCA 2 Section A – This ONE question is compulsory and MUST be attempted 1 You are a manager in the audit department of Snow & Co, a firm of Chartered

Managing conflict Avoiding tActics - ACCA Global

AccEss tHE ARticlE HERE vAluE AddEd tAx – PARt 1 releVAnt to ACCA QuAlIFICAtIon PAPer F6 (uK) In the first article of two, Paper F6 (UK) examiner David Harrowven describes how VAT will be examined in Paper F6 (UK) Among the areas discussed in the article are VAT registration and deregistration, and output and input VAT AccEss tHE ARticlE HERE

THE IMPLICATIONS OF CORPORATE SOCIAL RESPONSIBILITY ON THE

For example, ACCA investigated since 2003 “How the environment influences corporate profit”, continued in 2004 with “The changing role of business in society”, and issued in 2005 a “Stakeholder engagement reporting” More recently, ACCA focuses on carbon reporting guidance (CAPA, p 22)

Strategic Management: The theory and practice of strategy in

Strategic Management: The Theory and Practice of Strategy in (Business) Organizations S Jofre Foreword The present report is the result of an ongoing study on the patterns and trends on both the theory and

GUIDANCE Independent examination of charity accounts

change from time to time as the regulations made under the 2011 Act are updated The trustees may opt for an independent examination provided an audit is not required by charity law or for some other reason (see section 3) The content of an independent examination is specified: What you must do is set out in the

VALUATION OF UNQUOTED SHARES - CBDT ISSUED AMENDED RULE

tax bulletin june, 2018 volume - 18 - the institute of cost accountants of india 9 valuation of unquoted shares - cbdt issued amended rule - 11ua -

2019ESC Guidelines for the diagnosisand - Portail Vasculaire

Associations: Acute Cardiovascular Care Association (ACCA), Association of Cardiovascular Nursing & Allied Professions (ACNAP), European Association of Cardiovascular Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), Heart Failure Association (HFA) Councils: Council on Cardiovascular Primary Care

SEANCE DU 27 AVRIL 2012 2011 À 20 H 00 - courmangouxfr

d COURRIER DE L’ACCA Mme le Maire fait part d’une demande du président de l’ACCA pour poser de l’enrobé devant le portail d’entrée du local de la Cure, ainsi que le remplacement du cheneau du toit Cette demande sera étudiée dans le cadre de la mise aux normes des travaux de la mairie

ECHO CHAMPAGNARD JUILLET 2011 N°21

SIGREDA pour rectifier l’article 2 des statuts comme suit « son siège est fixé 5, rue du Portail Rouge 35450 VIF » Après délibération, la modification des statuts du SIGREDA est acceptée Pour : 14 – Contre : 0 – Abstention : 0 Création et suppression de poste Compte tenu du tableau d’avancement de grade 2011

[PDF] ACCA Perspectives commerciales – Decembre 2016

[PDF] ACCA-Perspectives-commerciales-Mai-2016

[PDF] Accademia di Belle Arti di Brera, Milano – WS 2013/ 14

[PDF] ACCADEMIA DI BELLE ARTI ERASMUS + Istituzioni Partner dell

[PDF] ACCADEMIA DI MUSICA ITALIANA PER ORGANO (Pistoia

[PDF] Accaparement de terres agricoles - France, Inde (23.06

[PDF] accaparements des terres :les paysans debout

[PDF] Accaparements fonciers à grande échelle, capital financier et - Gestion De Projet

[PDF] Accastillage - Cour Et Terrasse

[PDF] Accastillage - CAP Maquettes - France

[PDF] ACCASTILLAGE BOOMERANG 01 12 15 Erik jouet cataboomerang - Anciens Et Réunions

[PDF] Accastillage KDH 127 Accastillage Pekabe 127

[PDF] AccÃ©der Ã l`article complet en francais - Anciens Et Réunions

[PDF] ACCC Utilisation de Documents, Communication

[PDF] ACCC/C/2013/92 From the communicant to ACCC

2019 ESC Guidelines for the diagnosis and

management of acute pulmonaryembolism developed in collaboration with the European

Respiratory Society (ERS)

The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) Authors/Task Force Members: Stavros V. Konstantinides* (Chairperson) (Germany/ Greece), Guy Meyer* (Co-Chairperson) (France), Cecilia Becattini (Italy), He´ctor Bueno (Spain), Geert-Jan Geersing (Netherlands), Veli-Pekka Harjola (Finland),

Menno V. Huisman (Netherlands), Marc Humbert

1 (France), Catriona Sian Jennings (United Kingdom), David Jime´nez (Spain), Nils Kucher (Switzerland), Irene Marthe Lang (Austria), Mareike Lankeit (Germany), Roberto Lorusso (Netherlands), Lucia Mazzolai (Switzerland), Nicolas

Meneveau (France), Fionnuala N

?ı?Ainle (Ireland), Paolo Prandoni (Italy), Piotr Pruszczyk (Poland), Marc Righini (Switzerland), Adam Torbicki (Poland), Eric Van Belle (France), Jose´ Luis Zamorano (Spain)

* Corresponding authors: Stavros V. Konstantinides, Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Building 403, Langenbeckstr. 1, 55131 Mainz,

Germany. Tel:þ49 613 117 6255, Fax:þ49 613 117 3456, Email: stavros.konstantinides@unimedizin-mainz.de; and Department of Cardiology, Democritus University of Thrace,

68100 Alexandroupolis, Greece. Email: skonst@med.duth.gr. Guy Meyer, Respiratory Medicine Department, Hoˆpital Europe´en Georges Pompidou, 20 Rue Leblanc, 75015 Paris,

France. Tel:þ33 156 093 461, Fax:þ33 156 093 255, Email: guy.meyer@aphp.fr; and Universite´ Paris Descartes, 15 rue de l"e´cole de me´decine 75006 Paris, France.

Author/Task Force Member Affiliations: listed in the Appendix.

ESC Committee for Practice Guidelines (CPG) and National Cardiac Societies document reviewers:listed in the Appendix.

Representing the ERS.

ESC entities having participated in the development of this document:

Associations: Acute Cardiovascular Care Association (ACCA), Association of Cardiovascular Nursing & Allied Professions (ACNAP), European Association of Cardiovascular

Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), Heart Failure Association (HFA).

Councils: Council on Cardiovascular Primary Care.

Working Groups: Aorta and Peripheral Vascular Diseases, Cardiovascular Surgery, Pulmonary Circulation and Right Ventricular Function, Thrombosis.

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 theEuropean Heart Journaland the party authorized to handle such permissions on behalf of the ESC (journals.permissions@oxfordjournals.org).

Disclaimer. The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge, and the evidence available

at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the ESC Guidelines and any other official recom-

mendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encour-

aged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or

therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accu-

rate decisions in consideration of each patient"s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient"s caregiver. Nor do the

ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public

health authorities, in order to manage each patient"s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health

professional"s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

European Heart Journal (2019)00,1?61

ESC GUIDELINES

doi:10.1093/eurheartj/ehz405Downloaded from https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehz405/5556136 by guest on 31 August 2019

Document Reviewers: Nazzareno Galie´ (CPG Review Coordinator) (Italy), J. Simon R. Gibbs (CPG Review

Coordinator) (United Kingdom), Victor Aboyans (France), Walter Ageno (Italy), Stefan Agewall (Norway),

Ana G. Almeida (Portugal), Felicita Andreotti (Italy), Emanuele Barbato (Italy), Johann Bauersachs (Germany), Andreas Baumbach (United Kingdom), Farzin Beygui (France), Jørn Carlsen (Denmark),

Marco De Carlo (Italy), Marion Delcroix

1 (Belgium), Victoria Delgado (Netherlands), Pilar Escribano Subias (Spain), Donna Fitzsimons (United Kingdom), Sean Gaine 1 (Ireland), Samuel Z. Goldhaber (United States of America), Deepa Gopalan (United Kingdom), Gilbert Habib (France), Sigrun Halvorsen (Norway),

David Jenkins (United Kingdom), Hugo A. Katus (Germany), Barbro Kjellstro¨m (Sweden), Mitja Lainscak

(Slovenia), Patrizio Lancellotti (Belgium), Geraldine Lee (United Kingdom), Gre´goire Le Gal (Canada),

Emmanuel Messas (France), Joao Morais (Portugal), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Massimo Francesco Piepoli (Italy), Susanna Price (United Kingdom), Marco Roffi (Switzerland), Aldo Salvi (Italy), Olivier Sanchez 1 (France), Evgeny Shlyakhto (Russian Federation), Iain A. Simpson (United Kingdom), Stefan Stortecky (Switzerland), Matthias Thielmann (Germany), Anton Vonk Noordegraaf 1 (Netherlands)

The disclosure forms of all experts involved in the development of these Guidelines are available on the

ESC websitewww.escardio.org/guidelines

For the Supplementary Data which include background information and detailed discussion of the data

that have provided the basis for the Guidelines seehttps://academic.oup.com/eurheartj/article-lookup/doi/

Keywords

Guidelines

pulmonary embolism venous thrombosis shock dyspnoea heart failure right ven- tricle diagnosis risk assessment echocardiography biomarkers treatment anticoagulation thrombolysis pregnancy venous thromboembolism embolectomy

Abbreviationsandacronyms ........................................ 4

1Preamble......................................................... 5

2Introduction...................................................... 6

2.1 Whydo weneednewGuidelinesonthe diagnosisand

managementofpulmonaryembolism? ............................ 6

2.2Whatisnewinthe2019Guidelines? .......................... 7

2.2.1New/revisedconceptsin2019 ............................ 7

2.2.2 Changesin recommendations2014?19 .................. 7

2.2.3Mainnewrecommendations2019 ........................ 8

3Generalconsiderations ........................................... 8

3.1Epidemiology................................................. 8

3.2Predisposingfactors .......................................... 9

3.3Pathophysiologyanddeterminantsofoutcome ............... 10

4Diagnosis........................................................ 12

4.1Clinicalpresentation......................................... 12

4.2 Assessmentofclinical (pre-test) probability .. ... .. ... ... .. ... . 12

4.3 Avoidingoveruse ofdiagnostic testsforpulmonary

embolism....................................................... 13

4.4D-dimertesting ............................................. 13

4.4.1Age-adjustedD-dimercut-offs ........................... 13

4.4.2 D-dimercut-offsadaptedto clinicalprobability .. ... .. ... . 13

4.4.3Point-of-careD-dimerassays ............................ 134.5Computedtomographic pulmonary angiography . ... .. ... .. ... 13

4.6Lungscintigraphy ............................................ 14

4.7Pulmonaryangiography ...................................... 15

4.8Magneticresonanceangiography ............................. 15

4.9Echocardiography ........................................... 15

4.10Compressionultrasonography .............................. 16

4.12Computedtomographyvenography ........................ 18

5Assessmentofpulmonaryembolismseverityandtherisk of

earlydeath ........................................................ 18

5.1Clinical parametersofpulmonaryembolismseverity .. ... .. ... 18

5.2Imagingofrightventricularsizeandfunction .................. 18

5.2.1Echocardiography ....................................... 18

5.2.2 Computedtomographicpulmonary angiography . ... .. ... 19

5.3Laboratorybiomarkers ...................................... 19

5.3.1Markersofmyocardialinjury ............................. 19

5.3.2Markersofrightventriculardysfunction .................. 19

5.3.3Otherlaboratorybiomarkers ............................ 19

5.4Combined parametersandscoresforassessmentof

pulmonaryembolismseverity ................................... 20

5.5 Integration of aggravating conditions and comorbidity

intoriskassessmentofacute pulmonary embolism .. ... .. ... .. ... 20

5.6Prognosticassessmentstrategy .............................. 20

6Treatmentintheacutephase .................................... 22

6.1Haemodynamicandrespiratorysupport...................... 22

6.1.1Oxygentherapyandventilation .......................... 22

2ESC GuidelinesDownloaded from https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehz405/5556136 by guest on 31 August 2019

6.1.2 Pharmacological treatmentofacuterightventricular

failure........................................................ 22

6.1.3 Mechanical circulatorysupportandoxygenation . ... .. ... . 23

6.1.4Advancedlifesupportincardiacarrest ................... 23

6.2Initialanticoagulation ........................................ 23

6.2.1Parenteralanticoagulation ............................... 23

6.2.2 Non-vitaminK antagonistoral anticoagulants . ... ... .. ... . 24

6.2.3VitaminKantagonists.................................... 24

6.3Reperfusiontreatment....................................... 24

6.3.1Systemicthrombolysis................................... 24

6.3.2 Percutaneouscatheter-directedtreatment . .. ... ... .. ... . 25

6.3.3Surgicalembolectomy ................................... 25

6.4Multidisciplinarypulmonaryembolismteams ................. 26

6.5Venacavafilters ............................................. 26

7 Integratedrisk-adapteddiagnosisandmanagement .. .. ... ... .. ... . 28

7.1Diagnosticstrategies......................................... 28

7.1.1 Suspectedpulmonaryembolismwith haemodynamic

instability..................................................... 29

7.1.2 Suspectedpulmonaryembolismwithouthaemodynamic

instability..................................................... 30 angiography ............................................... 30

7.1.2.2 Strategy basedonventilation/perfusion

scintigraphy................................................ 30

7.2Treatmentstrategies ........................................ 30

7.2.1 Emergencytreatmentofhigh-risk pulmonary embolism .. . 30

7.2.2 Treatmentofintermediate-riskpulmonaryembolism . ... . 30

7.2.3 Managementoflow-riskpulmonaryembolism:triage

forearlydischarge andhometreatment . ... .. ... .. ... ... .. ... . 30

8 Chronictreatmentandpreventionofrecurrence ... .. ... ... .. ... . 32

8.1 Assessmentofvenousthromboembolism

recurrencerisk ................................................. 33

8.2Anticoagulant-relatedbleedingrisk ........................... 34

8.3 Regimensandtreatmentdurationswith non-vitamin

K antagonist oral anticoagulants, andwith othernon-vitamin Kantagonistantithromboticdrugs ............................... 34

8.5 Managementofpulmonaryembolismin patients

withcancer ..................................................... 36

9Pulmonaryembolismandpregnancy.............................. 37

9.1 Epidemiology andriskfactorsforpulmonaryembolism

inpregnancy .................................................... 37

9.2 Diagnosisofpulmonaryembolisminpregnancy . .. ... ... .. ... . 37

9.2.1 Clinical prediction rulesandD-dimers . .. ... .. ... ... .. ... . 37

9.2.2Imagingtests ............................................ 37

9.3Treatmentofpulmonaryembolisminpregnancy.............. 39

9.3.1 Role ofamultidisciplinarypregnancyheartteam . ... .. ... . 40

9.4Amnioticfluidembolism ..................................... 40

10Long-termsequelaeofpulmonaryembolism..................... 41

pulmonaryembolism............................................ 41

10.2Chronicthromboembolicpulmonaryhypertension . ... .. ... . 4110.2.1Epidemiology,pathophysiology,andnaturalhistory . .. ... 41

10.2.2Clinicalpresentationanddiagnosis . ... .. ... ... .. ... .. ... 42

10.2.3Surgicaltreatment ..................................... 42

10.2.4Balloonpulmonaryangioplasty ......................... 43

10.2.5Pharmacologicaltreatment ............................. 43

embolism....................................................... 44

11Non-thromboticpulmonaryembolism .......................... 45

12Keymessages .................................................. 45

13Gapsintheevidence ........................................... 46

14Whattodo"andwhatnot to do"messagesfromthe

Guidelines ........................................................ 47

15Supplementarydata ............................................ 48

16Appendix ...................................................... 48

17References ..................................................... 49

Recommendations

4.11Recommendationsfordiagnosis ............................... 17

5.7Recommendationsforprognosticassessment ................... 22

6.6Recommendationsforacute-phase treatmentofhigh-risk

pulmonaryembolism .............................................. 26

6.7Recommendationsforacute-phase treatmentofintermediate-

orlow-riskpulmonaryembolism .................................. 27 teams ............................................................ 27

6.9Recommendationsforinferiorvenacavafilters .................. 27

6.10Recommendationsforearlydischargeandhometreatment .. ... 27

8.4Recommendationsfortheregimen andthedurationof

anticoagulationafterpulmonaryembolism in patientswithout cancer ............................................................ 35

8.6Recommendationsfortheregimen andthedurationof

anticoagulationafterpulmonaryembolism in patientswithactive cancer ............................................................ 37

9.5Recommendationsforpulmonary embolisminpregnancy .. .. ... 40

10.4Recommendationsforfollow-upafteracute pulmonary

embolism ......................................................... 45

List of tables

Table1Classesofrecommendation................................. 6 Table2Levelsofevidence .......................................... 6 Table3 Predisposingfactorsforvenousthromboembolism . ... .. ... 10 Table4 Definitionofhaemodynamicinstability,whichdelineates acutehigh-riskpulmonaryembolism ............................... 11 Table5 TherevisedGenevaclinical predictionrule forpulmonary embolism ......................................................... 12 Table6 Imagingtestsfordiagnosisofpulmonaryembolism .. ... .. ... 14

Table7 OriginalandsimplifiedPulmonaryEmbolism

SeverityIndex ..................................................... 20 Table8 Classificationofpulmonaryembolismseverityandthe riskofearly(in-hospitalor30-day)death ........................... 21

ESC Guidelines3Downloaded from https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehz405/5556136 by guest on 31 August 2019

quotesdbs_dbs11.pdfusesText_17

[PDF] 2019ESC Guidelines for the diagnosisand - Portail Vasculaire