Chronic Thromboembolic Pulmonary Hypertension
Publication Date: December 1, 2018
In addition to chronic anticoagulation therapy, each patient with chronic thromboembolic disease (CTEPH) should receive treatment assessment starting with evaluation for pulmonary endarterectomy (PEA), which is the guideline recommended treatment.
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For technically inoperable cases, PH-targeted medical therapy is recommended (currently riociguat based on the CHEST studies), and balloon pulmonary angioplasty should be considered at a centre experienced with this challenging but potentially effective and complementary intervention.
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CTEPH treatment guidelines should not be applied to chronic thromboembolic disease (CTED).
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PEA should be offered to all eligible patients with CTEPH.
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Balloon pulmonary angioplasty (BPA) should be reserved for expert centres, where it should be considered for symptomatic CTEPH patients ineligible for PEA due to distal chronic thromboembolism or persistent/recurrent PH after surgery.
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BPA complications should be defined and uniformly reported.
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An expert CTEPH centre should be able to assess and deliver all established treatment modalities with outcomes similar to or exceeding those published.
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Patients with operable CTEPH should receive PEA as the treatment of choice.
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Patients with persistent/recurrent symptomatic PH following PEA should receive medical therapy and be considered for BPA or re-do endarterectomy in cases of significant re-occlusion.
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Chronic thromboembolic pulmonary hypertension (CTEPH): revised treatment algorithm.
Recommendation Grading
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Overview
Title
Chronic Thromboembolic Pulmonary Hypertension
Authoring Organization
Publication Month/Year
December 1, 2018
Document Type
Other
External Publication Status
Published
Country of Publication
European
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Operating and recovery room
Intended Users
Social worker, paramedic emt, athletics coaching, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D006976 - Hypertension, Pulmonary, D013923 - Thromboembolism
Keywords
pulmonary hypertension, pulmonary embolism, Chronic thromboembolic, pulmonary endarterectomy, pulmonary angioplasty