PMID- 32668468
OWN - NLM
STAT- MEDLINE
DCOM- 20210201
LR  - 20210201
IS  - 1439-4413 (Electronic)
IS  - 0012-0472 (Linking)
VI  - 145
IP  - 14
DP  - 2020 Jul
TI  - [Antithrombotic Treatment of Pulmonary Embolism].
PG  - 970-977
LID - 10.1055/a-0955-3379 [doi]
AB  - The present article addresses clinical challenges associated with the choice of 
      the anticoagulant agent, the definition of the duration of anticoagulant 
      treatment and the assessment of the risk-to-benefit ratio of prolonged 
      anticoagulation for patients with pulmonary embolism (PE).Anticoagulation is 
      performed with unfractionated heparin (UFH) in hemodynamically unstable patients 
      and with low molecular weight heparins (LWMH) or fondaparinux in normotensive 
      patients. In patients with high or intermediate clinical probability of pulmonary 
      embolism, anticoagulation should be initiated without delay while awaiting the 
      results of diagnostic tests. LMWH and fondaparinux are preferred over UFH in the 
      initial anticoagulation of PE since they are associated with a lower risk of 
      bleeding.All patients with PE require therapeutic anticoagulation for at least 
      three months. The current 2019 guidelines of the European Society of Cardiology 
      (ESC) recommend that all eligible patients should be treated with a non-vitamin K 
      antagonist oral anticoagulant (NOAC) in preference to a vitamin K antagonist 
      (VKA). In patients with active cancer, Apixaban, Edoxaban and Rivaroxaban are 
      effective alternatives to treatment with LMWH.The decision on the duration of 
      anticoagulation should consider both, the individual risk of PE recurrence and 
      the individual risk of bleeding. The risk for recurrent PE after discontinuation 
      of treatment is related to the features of the index PE event. While patients 
      with a strong transient risk factor have a low risk of recurrence and 
      anticoagulation can be discontinued after three months, patients with strong 
      persistent risk factor (such as active cancer) have a high risk of recurrence and 
      thus should receive anticoagulant treatment of indefinite duration. Given the 
      favourable safety profile of NOACs (especially if a reduced dosage of Apixaban or 
      Rivaroxaban is initiated after at least six months of therapeutic 
      anticoagulation), extended oral anticoagulation of indefinite duration should be 
      considered for all patients with intermediate risk of recurrence.
CI  - (c) Georg Thieme Verlag KG Stuttgart . New York.
FAU - Ebner, Matthias
AU  - Ebner M
FAU - Lankeit, Mareike
AU  - Lankeit M
LA  - ger
PT  - Journal Article
TT  - Antithrombotische Therapie bei Lungenembolie.
DEP - 20200715
PL  - Germany
TA  - Dtsch Med Wochenschr
JT  - Deutsche medizinische Wochenschrift (1946)
JID - 0006723
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Pyrazoles)
RN  - 0 (Pyridines)
RN  - 0 (Pyridones)
RN  - 0 (Thiazoles)
RN  - 3Z9Y7UWC1J (apixaban)
RN  - 9005-49-6 (Heparin)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
RN  - J177FOW5JL (Fondaparinux)
RN  - NDU3J18APO (edoxaban)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Acute Disease
MH  - Dalteparin/adverse effects/therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Fondaparinux/adverse effects/therapeutic use
MH  - Guideline Adherence
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/therapeutic use
MH  - Humans
MH  - Long-Term Care
MH  - Neoplasms/drug therapy
MH  - Pulmonary Embolism/*drug therapy
MH  - Pyrazoles/adverse effects/therapeutic use
MH  - Pyridines/adverse effects/therapeutic use
MH  - Pyridones/adverse effects/therapeutic use
MH  - Recurrence
MH  - Risk Assessment
MH  - Risk Factors
MH  - Rivaroxaban/adverse effects/therapeutic use
MH  - Thiazoles/adverse effects/therapeutic use
COIS- Matthias Ebner gibt an, dass kein Interessenkonflikt vorliegt.Mareike Lankeit hat 
      Honorare fur Referenten-/Beratertatigkeit von Actelion, Bayer, BRAHMS - Thermo 
      Fisher Scientific, Daiichi-Sankyo, MSD, Pfizer - Bristol-Myers Squibb und 
      Forschungsforderung vom Bundesministerium fur Bildung und Forschung (BMBF 
      01EO1003 und 01EO1503) sowie BRAHMS - Thermo Fisher Scientific erhalten.
EDAT- 2020/07/16 06:00
MHDA- 2021/02/02 06:00
CRDT- 2020/07/16 06:00
PHST- 2020/07/16 06:00 [entrez]
PHST- 2020/07/16 06:00 [pubmed]
PHST- 2021/02/02 06:00 [medline]
AID - 10.1055/a-0955-3379 [doi]
PST - ppublish
SO  - Dtsch Med Wochenschr. 2020 Jul;145(14):970-977. doi: 10.1055/a-0955-3379. Epub 
      2020 Jul 15.