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. 2017 May;19(Suppl D):D309-D332.
doi: 10.1093/eurheartj/sux030. Epub 2017 May 2.

ANMCO Position Paper: long-term follow-up of patients with pulmonary thromboembolism

Carlo D'Agostino  1 , Pietro Zonzin  2 , Iolanda Enea  3 , Michele Massimo Gulizia  4 , Walter Ageno  5 , Piergiuseppe Agostoni  6 , Michele Azzarito  7 , Cecilia Becattini  8 , Amedeo Bongarzoni  9 , Francesca Bux  10 , Franco Casazza  11 , Nicoletta Corrieri  12 , Michele D'Alto  13 , Nicola D'Amato  10 , Andrea Maria D'Armini  14 , Maria Grazia De Natale  8 , Giovanni Di Minno  15 , Giuseppe Favretto  16 , Lucia Filippi  17 , Valentina Grazioli  14 , Gualtiero Palareti  18 , Raffaele Pesavento  17 , Loris Roncon  19 , Laura Scelsi  20 , Antonella Tufano  15
Affiliations

ANMCO Position Paper: long-term follow-up of patients with pulmonary thromboembolism

Carlo D'Agostino et al. Eur Heart J Suppl. 2017 May.

Abstract

Venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis, is the third most common cause of cardiovascular death. The management of the acute phase of VTE has already been described in several guidelines. However, the management of the follow-up (FU) of these patients has been poorly defined. This consensus document, created by the Italian cardiologists, wants to clarify this issue using the currently available evidence in VTE. Clinical and instrumental data acquired during the acute phase of the disease are the cornerstone for planning the FU. Acquired or congenital thrombophilic disorders could be identified in apparently unprovoked VTE during the FU. In other cases, an occult cancer could be discovered after a VTE. The main targets of the post-acute management are to prevent recurrence of VTE and to identify the patients who can develop a chronic thromboembolic pulmonary hypertension. Knowledge of pathophysiology and therapeutic approaches is fundamental to decide the most appropriate long-term treatment. Moreover, prognostic stratification during the FU should be constantly updated on the basis of the new evidence acquired. Currently, the cornerstone of VTE treatment is represented by both the oral and the parenteral anticoagulation. Novel oral anticoagulants should be an interesting alternative in the long-term treatment.

Keywords: Consensus document; Deep vein thrombosis; Prognosis; Pulmonary embolism; Treatment; Venous thromboembolism.

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Figures

Figure 1
Figure 1
Decision algorithm for follow-up of venous thromboembolic patients. VTE, venous thromboembolism; PH, pulmonary hypertension; lab, laboratory; FU, follow up; RV, right ventricle; V/Q Scan, ventilation/perfusion scintigraphy; RHC, right heart catheterization; Angio, angiopneumography; PAH, pulmonary artery hypertension; MAP, pulmonary mean arterial pressure; PR, pulmonary resistance; GP: general practitioner; PEA, pulmonary endoarterectomy; Angio CT, computed angio tomography.
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