Evaluation and management of chronic pulmonary thromboembolic disease.

摘要: Pulmonary embolism (PE) is common and the majority of patients survive acute event. Survivors are at increased risk for adverse outcomes, including persistent thrombi, recurrent embolism, chronic thromboembolic pulmonary hypertension (CTEPH), death. Anticoagulation protects against recurrence, which has a high mortality rate. The recommended duration anticoagulation with reversible PE factors 3 months. For idiopathic or factors, extended preferred, balanced an individual patient's hemorrhage, in itself major cause morbidity mortality. Among malignancy who develop venous thromboembolism (VTE), low-molecular-weight heparin preferred over oral vitamin K antagonists first 6 Thereafter, should be continued indefinitely either antagonists. Inferior vena cava filters not routinely only used have contraindication to anticoagulation. Patients had VTE dyspnea evaluated recurrence development CTEPH. anticoagulated indefinitely. Routine screening CTEPH asymptomatic recommended. Echocardiography often provides indication presence hypertension. Once established by right-sided heart catheterization perfusion imaging (ie, ventilation/perfusion scintigraphy, computed tomography angiography, angiography), referred early center expertise, as it potentially surgically curable endarterectomy. Those deemed inoperable after being may gain symptomatic benefit from drugs approved arterial Lung transplantation also option candidates