| Autor: |
Picariello C; U.O.C. Cardiologia, Azienda Ospedaliera S. Maria della Misericordia, Rovigo., Garascia A; Dipartimento Cardiotoracovascolare 'A. De Gasperis', ASST Grande Ospedale Metropolitano Niguarda, Milano., Giordana F; U.O.C. Cardiologia, Ospedale S. Croce e Carle, Cuneo., Lo Giudice F; Dipartimento di Cardiologia, Hammersmith Hospital, Imperial College NHS Trust, Londra, UK., Romaniello A; U.O.C. Cardiologia, Azienda Ospedaliero-Universitaria Sant'Andrea, Roma., Vedovati MC; S.C. Medicina Interna, Vascolare e d'Urgenza - Stroke Unit, Università degli Studi, Perugia., Enea I; U.O.C. Medicina e Chirurgia d'Urgenza, A.O.R.N. 'S. Anna e S. Sebastiano', Caserta., Caravita S; Istituto Auxologico Italiano, IRCCS Ospedale San Luca, Milano - Dipartimento di Ingegneria Gestionale, dell'Informazione e della Produzione, Università degli Studi di Bergamo, Dalmine (BG)., Camassa N; U.O.C. Cardiologia Ospedaliera, Policlinico di Bari., Vatrano M; U.O.C. Cardiologia, Azienda Ospedaliera 'Pugliese-Ciaccio', Catanzaro., Bongarzoni A; U.O.C. Cardiologia, ASST Santi Paolo e Carlo, Milano., Roncon L; U.O.C. Cardiologia, Azienda Ospedaliera S. Maria della Misericordia, Rovigo., Gabrielli D; U.O.C. Cardiologia, Ospedale San Camillo Forlanini, Roma., Colivicchi F; U.O.C. Cardiologia, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma. |
| Abstrakt: |
Patients with pulmonary embolism are a heterogeneous population and, after the acute phase and the first 3-6 months, the main issue is whether to continue, and hence how long and at what dose, or to stop anticoagulation therapy. In patients with venous thromboembolism (VTE), direct oral anticoagulants (DOACs) are the recommended treatment (class I, level of evidence B in the latest European guidelines), and in most cases, an "extended" or "long-term" low-dose therapy is warranted. This paper aims to provide a practical management tool to the clinician dealing with pulmonary embolism follow-up: from the evidence behind the most used exams (D-dimer, ultrasound Doppler of the lower limbs, imaging tests, recurrence and bleeding risk scores), and the use of DOACs in the extended phase, to six real clinical scenarios with the relative management in the acute phase and at follow-up. Lastly, a practical algorithm is shown to deal with anticoagulation therapy in the follow-up of VTE patients in a simple, schematic, and pragmatic way. |
