#Pulmonary_Embolism_10 #PE PE treatment part 4 #ESC #BMJ ن | "لعلي أفيدك" Clinical discussion

#Pulmonary_Embolism_10 #PE
PE treatment part 4 #ESC #BMJ
نختم موضوع ال PE

حالات ال Low- Intermediate Risk PE
ال 1st choise هو استخدام ال Anticoagulant ..
والأولوية لاستخدام ال LMWH او ال Fondaparinux ويعتبرو أفضل من ال UFH

Routine primary reperfusion treatment, notably full-dose systemic thrombolysis, is not recommended, as the risk of potentially life-threatening bleeding complications appears too high for the expected benefits from this treatment.

مريض ال Intermediate-High risk بنمشيه ع anticoagulant
وبنراقبه ، لو دخل ب Hemodynamic Instability ساعتها بنعطيه Thrombolysis

Rescue thrombolytic therapy or, alternatively, surgical embolectomy or percutaneous catheter-directed treatment should be reserved for patients who develop signs of haemodynamic instability.

ال preferred لل Intermediate high risk انه يضل على LMWH لمدة يومين- ثلاثة أيام ، لو ضل المريض stable
بنشفته ع Oral Anticoagulant

وال NOACs مفضله عن ال Warfarin ك Oral agent

لو كان المريض عنده C.I لاستخدام ال Anticoagulant
فبنلجأ لاستخدام ال IVC Filter
Indication of IVC Filter :
IVC filters should be considered in patients with acute PE and absolute contraindications to anticoagulation.

تاني Indication لل IVC Filter هو ال Recurrent PE رغم ان المريض وصل لل Therapeutic Anticoagulant

IVC filters should be considered in cases of PE recurrence despite therapeutic anticoagulation.

طيب خلصنا من ال Acute phase سواء كان المريض High risk او Low- Intermediate risk ...
كم المدة اللي هيضل المريض ماشي فيها على Anticoagulant
اقل فتره ممكنة لأي مريض PE هي 3 شهور
فكل ال Pt ما لم يكن عندهم ما يمنع من استخدام ال Anticoagulant هيمشو لمدة 3 شهور على Oral Anticoagulant

لو كانت ال PE صارت أول مرة مع المريض
و سببها Major Transient Reversible factor
ف ال 3 شهور كافيه وبنوقف بعدها ال Anticoagulant

لو كان سبب ال PE مش معروف " Unprovoked" او سبب Minor او Irreversible Persistent factor
فهنا مدة ال Anticoagulant هتزيد عن 3 شهور

indefinite oral anticoagulation recommended for patients with any of the following;

recurrent venous thromboembolism with at least 1 previous episode of PE or deep venous thromboembolism not related to major transient or reversible factors (ESC/ERS Class I, Level B)

antiphospholipid antibody syndrome (VKA treatment recommended)

extended oral anticoagulation suggested for patients with first episode of PE and any of the following ;

no identifiable risk factor (ESC/ERS Class Ila, Level A)

persistent risk factor other than antiphospholipid antibody syndrome (ESC/ERS Class Ila, Level C)

PE associated with minor transient or reversible
risk factor (ESC/ERS Class Ila, Level C)
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