2019 European guidelines on the diagnostics and management of acute pulmonary thromboembolism: the comments from the experts of the Russian Cardiology Society and the Russian Respiratory Society

Novel guidelines presented at the annual congress of the European Society of Cardiology 2019 changed our knowledge on management of the acute pulmonary thromboembolism. They cover the issues of the risk stratification, management strategy in acute phase considering prognostic criteria nad patient’s hemodynamic stability, duration and scheme of the anticoagulation therapy in order to prevent thromboembolism recurrencies, management of patients with malignant tumors and in pregnant women, as well as the diagnostic and treatment approaches in postthrombotic syndrome. In the review, the experts of the Russian Cardiology Society and Russian Respiratory Society discuss the main questions and changes in the Guidelines on the acute pulmonary thromboembolism.

guidelines of the European Society of Cardiology, acute pulmonary thromboembolism, risk stratification, diagnostics, treatment, prevention of the recurrent thromboembolism, postthrombotic syndrome

1. Agnelli G, Verso M. Management of venous thromboembolism in patients with cancer. J Thromb Haemost. 2011; 9 Suppl 1:316-324.

2. Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712-1723.

3. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2019 Aug 31: 1-61. doi: 10.1093/eurheartj/ehz405.

4. Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing GJ, Kyrle PA. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost. 2016;14(7):1480-1483.

5. Douma RA, van Sluis GL, Kamphuisen PW, Söhne M, Leebeek FW, Bossuyt PM, Büller HR. Clinical decision rule and D-dimer have lower clinical utility to exclude pulmonary embolism in cancer patients. Explanations and potential ameliorations. Thromb Haemost. 2010;104(4):831-836.

6. Farge D, Bounameaux H, Brenner B, Cajfinger F, Debourdeau P, Khorana AA, Kakkar A. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. The Lancet Oncology. 2016;17(10): e452–e466.

7. Posch F, Konigsbrugge O, Zielinski C, Pabinger I, Ay C. Treatment of venous thromboembolism in patients with cancer: a network meta-analysis comparing efficacy and safety of anticoagulants. Thromb Res 2015;136 (3):582-589.

8. Raskob GE, van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 2018;378(7):615-624.

9. Young AM, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C, et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol 2018; 36 (20):2017-2023.

10. McBane R., Wysokinski WE, Le‐Rademacher JG, Zemla T, Ashrani A, Tafur A, et al. Apixaban and Dalteparin in Active Malignancy Associated Venous Thromboembolism: The ADAM VTE Trial. J Thromb Haemost. 2019 Oct 20. doi: 10.1111/jth.14662.

11. Agnelli G, Becattini C, Bauersachs R, Brenner B, Campanini M, Cohen A, et al. Apixaban versus Dalteparin for the Treatment of Acute Venous Thromboembolism in Patients with Cancer: The Caravaggio Study. Thromb Haemost. 2018;118(9):1668-1678.

12. Vedovati MC, Giustozzi M, Bonitta G, Agnelli G, Becattini C. Efficacy and safety of anticoagulant agents in patients with venous thromboembolism and cancer: A network meta-analysis. Thrombosis Research. 2018. doi: 10.1016/j.thromres.2018.08.023.

13. Louzada ML, Carrier M, Lazo-Langner A, Dao V, Kovacs MJ, Ramsay TO, et al. Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation 2012;126:448-454.