La Dra. Silvia Valbuena López apunta las novedades incluidas en el documento presentado en ESC Congress 2019.

1. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
European Heart Journal, ehz405, https://doi.org/10.1093/eurheartj/ehz405

2. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
What´s new in the 2019 Guidelines?
Diagnostic algorithm and role of diagnostic tests
Acute phase treatment
Chronic anticoagulation
Long term care/CTEPH
Pregnancy

3. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
DIAGNOSIS. Unstable patient algorithm
No clinical probability assessment
No D-dimer

4. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
DIAGNOSIS. Stable patient algorithm
No changes compared to 2014
If high probability  CTPA

5. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
DIAGNOSIS

6. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
RISK ASSESSMENT
• If not high risk use validated clinical prediction rules (PESI) for further stratification
• RV imaging and biomarkers should be performed despite low PESI

7. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
ACUTE PHASE TREATMENT
High risk Intermediate-low risk

8. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
CHRONIC PHASE TREATMENT. Duration
ALWAYS at least 3 months
Tailored duration of OAC depending on recurrence risk
No unprovoked PE!!!

9. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
CHRONIC PHASE TREATMENT. Duration

10. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
CHRONIC PHASE TREATMENT. Cancer
Indefinite treatment
LMWH, edoxaban or rivaroxaban
Indicación clase IIa

11. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
PREGNANCY
 First evidence of tailored diagnostic algorithm tested prospectively (2 studies)
 D-dimer use now recommended
 Objective  safely exclude PE reducing imaging test (radiation exposure)

12. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
PREGNANCY

13. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
PREGNANCY

14. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
Screening??? Not for everybody!
Risk factors for CTEPH
LONG-TERM FOLLOW-UP. CTEPH

15. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
LONG-TERM FOLLOW-P. CTEPH

16. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
CONCLUSIONES
El embarazo finalmente recibe atención
NOAC primera línea de tratamiento
Novedades en diagnóstico y tratamiento agudo
Factores de riesgo de CTEPH en pacientes sin disnea

17. Silvia Valbuena LópezESC GUIDELINES ON ACUTE PE
• Cambio de paradigma en el uso de fármacos hipoglucemiantes 
peso de la nueva evidencia científica
• Nueva clasificación del riesgo CV
• Intervención sobre el estilo de vida y aproximación multifactorial sobre
el riesgo cardiovascular
• Nuevos objetivos de TA y LDL
• Modificaciones en las recomendaciones en terapia antitrombótica
CONCLUSIONES