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Klok FA, Ageno W, Ay C, et al. Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society. Eur Heart J. 2021;doi: 10.1093/eurheartj/ehab816.
Klok, F. A., Ageno, W., Ay, C., Bäck, M., Barco, S., Bertoletti, L., Becattini, C., Carlsen, J., Delcroix, M., van Es, N., Huisman, M. V., Jara-Palomares, L., Konstantinides, S., Lang, I., Meyer, G., Ní Áinle, F., Rosenkranz, S., & Pruszczyk, P. (2021). Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society. European heart journal, . https://doi.org/10.1093/eurheartj/ehab816
Klok, Frederikus A, et al. "Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society." European heart journal vol. (2021). doi: https://doi.org/10.1093/eurheartj/ehab816
Klok FA, Ageno W, Ay C, Bäck M, Barco S, Bertoletti L, Becattini C, Carlsen J, Delcroix M, van Es N, Huisman MV, Jara-Palomares L, Konstantinides S, Lang I, Meyer G, Ní Áinle F, Rosenkranz S, Pruszczyk P. Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society. Eur Heart J. 2021 Dec 07; doi: 10.1093/eurheartj/ehab816. Epub 2021 Dec 07. PMID: 34875048.
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Eur Heart J. 2021 Dec 07; doi: 10.1093/eurheartj/ehab816. Epub 2021 Dec 07.

Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society.

European heart journal

Frederikus A Klok, Walter Ageno, Cihan Ay, Magnus Bäck, Stefano Barco, Laurent Bertoletti, Cecilia Becattini, Jørn Carlsen, Marion Delcroix, Nick van Es, Menno V Huisman, Luis Jara-Palomares, Stavros Konstantinides, Irene Lang, Guy Meyer, Fionnuala Ní Áinle, Stephan Rosenkranz, Piotr Pruszczyk

Affiliations

  1. Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands.
  2. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
  3. Department of Medicine and Surgery, University of Insubria, Varese, Italy.
  4. Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
  5. I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
  6. Center for Molecular Medicine and Department of Cardiology, Karolinska University Hospital, Solna, Sweden, Stockholm.
  7. INSERM U1116, Université de Lorraine, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre les Nancy, France.
  8. Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.
  9. Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne 42055, France.
  10. INSERM, UMR1059, Université Jean-Monnet, Saint-Etienne 42055, France.
  11. INSERM, CIC-1408, CHU de Saint-Etienne, Saint-Etienne 42055, France.
  12. INNOVTE, CHU de Saint-Etienne, Saint-Etienne 42055, France.
  13. Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
  14. Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  15. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
  16. Clinical Dept. of Respiratory Diseases, Pulmonary Hypertension Center, UZ Leuven, Leuven, Belgium.
  17. BREATHE, Dept CHROMETA, KU Leuven, Leuven, Belgium.
  18. Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, Netherlands.
  19. Medical Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario Virgen del Rocio, Seville, Spain.
  20. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  21. Department of Cardiology, Democritus University of Thrace, Greece.
  22. Department of Internal Medicine II, Cardiology and Center of Cardiovascular Medicine, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria.
  23. Respiratory Medicine Department, Hôpital Européen Georges Pompidou, Aphp, Paris, France.
  24. Université Paris Descartes, Paris 75006, France.
  25. Dept. of Hematology, Mater University Hospital and Rotunda Hospital, Dublin, Ireland.
  26. School of Medicine, University College Dublin, Dublin, Ireland.
  27. Dept. of Cardiology, Heart Center at the University of Cologne, Germany.
  28. Cologne Cardiovascular Research Center (CCRC), University of Cologne, Köln 50937, Germany.
  29. Dept. of Internal Medicine and Cardiology Medical University of Warsaw, Lindley St 4, Warsaw 00-005, Poland.

PMID: 34875048 DOI: 10.1093/eurheartj/ehab816

Abstract

This position paper provides a comprehensive guide for optimal follow-up of patients with acute pulmonary embolism (PE), covering multiple relevant aspects of patient counselling. It serves as a practical guide to treating patients with acute PE complementary to the formal 2019 European Society of Cardiology guidelines developed with the European Respiratory Society. We propose a holistic approach considering the whole spectrum of serious adverse events that patients with acute PE may encounter on the short and long run. We underline the relevance of assessment of modifiable risk factors for bleeding, of acquired thrombophilia and limited cancer screening (unprovoked PE) as well as a dedicated surveillance for the potential development of chronic thromboembolic pulmonary hypertension as part of routine practice; routine testing for genetic thrombophilia should be avoided. We advocate the use of outcome measures for functional outcome and quality of life to quantify the impact of the PE diagnosis and identify patients with the post-PE syndrome early. Counselling patients on maintaining a healthy lifestyle mitigates the risk of the post-PE syndrome and improves cardiovascular prognosis. Therefore, we consider it important to discuss when and how to resume sporting activities soon after diagnosing PE. Additional patient-relevant topics that require Focused counselling are travel and birth control.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Keywords: Anticoagulation therapy; Bleeding; Cardiovascular diseases; Contraceptive agents; Neoplasms; Pulmonary embolism; Pulmonary hypertension; Sports; Thrombophilia; Travel

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