This protocol applies to symptomatic patients with chronic thrombo-embolic pulmonary disease (CTEPD) who show mismatched perfusion defects on V/Q scan and evidence of chronic, organized, fibrotic clots on CTPA or DSA — but who do not have pulmonary hypertension.
Chronic thrombo-embolic pulmonary disease in this setting is defined by symptomatic patients with mismatched perfusion defects on V/Q scan and signs of chronic, organized, fibrotic clots on CTPA or DSA — such as ring-like stenoses, webs/slits, and chronic total occlusions (pouch lesions or tapered lesions) — after at least 3 months of therapeutic anticoagulation, in the absence of pulmonary hypertension.
The evidence-based approach in this population centres on long-term anticoagulant therapy, evaluated on an individual basis. Specific criteria — related to thromboembolic recurrence risk and prior venous thromboembolism history — govern whether anticoagulation is recommended. The complete structured regimen and decision criteria are available via the full protocol.
DOI: 10.1093/eurheartj/ehac237
Chronic thrombo-embolic pulmonary disease describes symptomatic patients with mismatched perfusion defects on V/Q scan and with signs of chronic, organized, fibrotic clots on CTPA or DSA, such as ring-like stenoses, webs/slits, and chronic total occlusions (pouch lesions or tapered lesions), after at least 3 months of therapeutic anticoagulation.
In patients with CTEPD without PH, long-term anticoagulant therapy should be considered on an individual basis.
Long-term anticoagulant therapy is recommended when the risk of PE recurrence is intermediate or high, or when there is no history of venous thrombo-embolism.
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