Non-thrombotic PE does not represent a distinct clinical syndrome. It may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the diagnosis difficult. With the exception of severe air and fat embolism, the haemodynamic consequences of non-thrombotic emboli are usually mild. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity.

/pdf/guidelines-on-the-diagnosis-and-management-of-acute-1usqw9xdub.pdf

Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)

ACS
: acute coronary syndrome
AMPLIFY
: Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-line Therapy
aPTT
: activated partial thromboplastin time
b.i.d.
: bis in diem (twice daily)
b.p.m.
: beats per minute
BNP
: brain natriuretic peptide
BP
: blood pressure
CI
: confidence interval
CO
: cardiac output
COPD
: chronic obstructive pulmonary disease
CPG
: Committee for Practice Guidelines
CRNM
: clinically relevant non-major
CT
: computed tomographic/tomogram
CTEPH
: chronic thromboembolic pulmonary hypertension
CUS
: compression venous ultrasonography
DSA
: digital subtraction angiography
DVT
: deep vein thrombosis
ELISA
: enzyme-linked immunosorbent assay
ESC
: European Society of Cardiology
H-FABP
: heart-type fatty acid-binding protein
HIT
: heparin-induced thrombocytopenia
HR
: hazard ratio
ICOPER
: International Cooperative Pulmonary Embolism Registry
ICRP
: International Commission on Radiological Protection
INR
: international normalized ratio
iPAH
: idiopathic pulmonary arterial hypertension
IVC
: inferior vena cava
LMWH
: low molecular weight heparin
LV
: left ventricle/left ventricular
MDCT
: multi-detector computed tomographic (angiography)
MRA
: magnetic resonance angiography
NGAL
: neutrophil gelatinase-associated lipocalin
NOAC(s)
: Non-vitamin K-dependent new oral anticoagulant(s)
NT-proBNP
: N-terminal pro-brain natriuretic peptide
o.d.
: omni die (every day)
OR
: odds ratio
PAH
: pulmonary arterial hypertension
PE
: pulmonary embolism
PEA
: pulmonary endarterectomy
PEITHO
: Pulmonary EmbolIsm THrOmbolysis trial
PESI
: pulmonary embolism severity index
PH
: pulmonary hypertension
PIOPED
: Prospective Investigation On Pulmonary Embolism Diagnosis
PVR
: pulmonary vascular resistance
RIETE
: Registro Informatizado de la Enfermedad Thromboembolica venosa
RR
: relative risk
rtPA
: recombinant tissue plasminogen activator
RV
: right ventricle/ventricular
SPECT
: single photon emission computed tomography
sPESI
: simplified pulmonary embolism severity index
TAPSE
: tricuspid annulus plane systolic excursion
Tc
: technetium
TOE
: transoesophageal echocardiography
TTR
: time in therapeutic range
TV
: tricuspid valve
UFH
: unfractionated heparin
V/Q scan
: ventilation–perfusion scintigraphy
VKA
: vitamin K antagonist(s)
VTE
: venous thromboembolism

Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

A great number of Guidelines have …

/pdf/2014-esc-guidelines-on-the-diagnosis-and-management-of-acute-1f9ulv0b8w.pdf

2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

https://journal.chestnet.org/article/S0012-3692(08)60132-4/pdf

Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

2008;133;141-159 Chest Samama and Jeffrey I. Weitz Jack Hirsh, Kenneth A. Bauer, Maria B. Donati, Michael Gould, Meyer M. Practice Guidelines (8th Edition) Clinical of Chest Physicians Evidence-Based Parenteral Anticoagulants: American College http://chestjournal.org/cgi/content/abstract/133/6_suppl/141S and services can be found online on the World Wide Web at: The online version of this article, along with updated information ). ISSN: 0012-3692. http://www.chestjournal.org/misc/reprints.shtml ( of the copyright holder may be reproduced or distributed without the prior written permission Northbrook IL 60062. All rights reserved. No part of this article or PDF by the American College of Chest Physicians, 3300 Dundee Road, 2007 Physicians. It has been published monthly since 1935. Copyright CHEST is the official journal of the American College of Chest

American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)

Term labor is associated with a core inflammatory response in human fetal membranes, myometrium, and cervix

Low molecular weight heparin for the treatment of venous thromboembolism in pregnancy: a case series.

Randomised trial of nitric oxide donor versus prostaglandin for cervical ripening before first-trimester termination of pregnancy

The use of low-molecular-weight heparin (LMWH) rather than unfractionated heparin in nonpregnant women with venous thromboembolism carries lower mortality and a decreased risk of hemorrhagic problems. Because LMWH is more bioavailable, has a longer half-life, and elicits a more predictable anticoagulant response, regular monitoring usually is not necessary as it is with unfractionated heparin. Experience with enoxaparin, a form of LMWH, was reviewed in 36 consecutive women seen at three maternity units in whom venous thromboembolism was objectively diagnosed (by Doppler ultrasound or ventilation/perfusion lung scanning) during or just after pregnancy. Enoxaparin was given subcutaneously in an approximate dose of 1 mg/kg twice a day on the basis of early pregnancy weight. Venous thromboembolism occurred antenatally in 29 women and postpartum in 7. These groups included six and five cases, respectively, of pulmonary embolism. Only one patient had a past history of venous thromboembolism. Peak levels of anti-Xa activity remained within the targeted therapeutic range in 30 women with no change in the dose of enoxaparin. Three other women required dose reduction on a single occasion. The median duration of treatment was 6 weeks. None of the women had antepartum bleeding or recurrent venous thromboembolism. Two women had local skin reactions and were given tinzaparin instead of enoxaparin. Three women had primary atonic postpartum bleeding amounting to less than 1 liter of blood but no disseminated intravascular coagulation or other complications. These cases were ascribed to tissue trauma. One woman had a wound hematoma that was evacuated. None of the women developed thrombocytopenia. Fifteen women received regional anesthesia for delivery and were given enoxaparin in a reduced dose of 40 mg daily with no complications. There were no unfavorable fetal outcomes. Enoxaparin, a form of LMWH, is a safe and effective means of treating venous thromboembolism during and shortly after pregnancy. Its administration is much simpler than that of unfractionated heparin, making outpatient care easier and enhancing patient acceptance of treatment. In addition, the use of LMWH may provide significant cost savings.

Ian A. Greer

Papers

Term labor is associated with a core inflammatory response in human fetal membranes, myometrium, and cervix

Low molecular weight heparin for the treatment of venous thromboembolism in pregnancy: a case series.

Randomised trial of nitric oxide donor versus prostaglandin for cervical ripening before first-trimester termination of pregnancy

Low molecular weight heparin for the treatment of venous thromboembolism in pregnancy: A case series

Vascular dysfunction and alteration of novel and classic cardiovascular risk factors in mothers of growth restricted offspring