WORLD CLINICAL DRUGS

Vol.37 NO.7

2014
*
( 200433)
(PE)
( 2014 ) 2008 2014

446

2014 PE

2016 Vol.37 No.7

+
R563.5R973 .2

1672-9188(2016)07-0446-07

DOI10.13683/j.wph.2016.07.004

2014 Guidelines of European Society of Cardiology on

the diagnosis and management of acute pulmonary embolism
JIANG Rong, LIU Jin-ming*
(Center of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China)

Abstract: As the widely used of new drugs, treatment, research, and exploration in patients with acute pulmonary
embolism (PE), the European Society of Cardiology (ESC) released a new guidelines on the diagnosis and management of
acute pulmonary embolism in 2014. Compared with the 2008 guidelines, the 2014 guidelines updated the risk assessment,
the new oral anticoagulants and some special problems. This review makes an interpretation of the updated part in 2014
guidelines for clinical practice.
Key words: acute pulmonary embolism; guidelines; diagnosis; treatment

2014 (ESC)
( 2014 ) 2000

1
(VTE) (

2008 ESC (PE)

) ( )

6 3

PE

VTE

2008 PE 2014

VTE [1]

VTE
3 6

2016-03-212016-04-17

(81500040)
(15ZR1434400)

3 VTE
60 [2] VTE
VTE

VTE [3]

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 , .2014 .

VTE [4]
PE (DVT)
PE

2016 37 7

1
Table 1 Clinical prediction rules for PE

Wells

PE DVT

1.5

100 bpm

1.5

PE

1.5

VTE

DVT

PE

PE [5]VTE
VTE

Well Geneva PE

PE

10% 30%

01

N/A

26

N/A

N/A

PE

04

01

PE

7594 bpm

> 95 bpm

65%PE
PE 12%[6]

3 D-
PE D-
80 10%
D-
(50 10 g/L)
34% 46% 97%
[7]

4 PE
CT (CTPA)

PE [8]
CTPA

CTPA PE

Geneva
PE DVT

>65

03

01

410

24

DVT

11

PE

05

02

PE

PE
1 2 mm
[9]
5 PE
CT PE

6 PE

PE

PE

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447
447
2016 Vol.37 No.7

( 1)

WORLD CLINICAL DRUGS

Vol.37 NO.7

PE CT

D-

[10]

30% PE D-

CTPA

DVT

PE CTPA

CTPA ( 1)

( 2)

PE CTPA
448
2016 Vol.37 No.7

PE

CTPA

PE
a

CTPA
CTPA

CTPA

PE
c

CTPA
CTPA

a. b. PE

c.

b
PE

Figure

1 PE

PE
algorithm
for patients
with suspected
high-risk PE, i.e.
c
PE

presenting with shock or hypotension

1
Proposed diagnostic

/PE

/PE

D-
PE

PE
CTPA
CTPA

/PE
/PE
D-

CTPA

CTPA

Figure 2 Proposed

PESI-
PESI sPESI
sPESI>1
PE
2

diagnostic
algorithm for patients with suspected not high-risk PESI-
pulmonary

sPESI-0

embolism

CTab
2

PESI-

c
PESI sPESI
sPESI>1

PESI-

sPESI-0

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, .2014 .
2016 37 7
PE
a

CTPA

7 PE

sPESI 0

30 d )
PE (

PE
PE ( 2)CTPA

PESI sPESI

( 3)PESI sPESI

(PESI)sPESI
]
b

CTPA

PESI
30 d 24.5%[11]
PESI PE

sPSEI 1
30 d 10.9%[12]
PESI (sPESI)
1

PE PE
PE

Xa

PE

PE
CTPA
VTE

[14]
/PE
/PE
-

D- [13]

( )

VTE

-
CTPA

CTPA

PESI sPESI 0

9 PE

PE

PESI
-

1
PESI-
sPESI>1

PESI sPESI
PESI-
sPESI-0

CTab

a. CT RV/LV 0.9
b. CT c.
d. e.
CT

3 PE
Figure 3 Risk-adjusted managemnet strategies in acute PE

TRV2.8 m/s
3
V/Q

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2016 Vol.37 No.7

( 3)

449
449

WORLD CLINICAL DRUGS

Vol.37 NO.7

2 PE
Table 2 Classification of patients with acute PE based on early mortality risk

PESI -sPESI1

()a

()b

a. ( ) /
CT - b. I T

450
2016 Vol.37 No.7

3 (PESI)
Table 3 Original and simplified PESI

1(80)

+10

+30

+10

+10

110 bpm

+20

100 mmHg

+30

30 bpm

+20

36

+20

+60

90%

+20

65 30 d(01.6%)6685
(1.7%3.5%)86105 (3.2%7.1%)
106125 (4.0%11.4%)125
(10%24.5%)

1
0=30 d1.0%(95%CI 02.1%)
1= 30 d10.9%(95%CI8.5%13.2%)

( )

sPESI 0

[11]

[13,15]

VTE

PE

[16] (

10 PE

CTPA) [13] 3

PE

PE

PE (LMWH)

11

[13]

PESI

(CTEPH)

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2016 37 7

, .2014 .

TRV2.8 m/s
3
V/Q

CTEPH

CTEPH

1-2

451
451

CTEPH

4 CTEPH
Figure 4 Alogrithm for the diagnosis of chronic thromboembolic pulmonary hypertension

VTE

[21] PE LMWH

[17] CTEPH

3 6 [22]

VTE

VTE

/ CTEPH

LMWH

(riociguat)
[18]

/ CTEPH

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( )

wcd@pharmadl.com
www.jwph.com.cn

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