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1 Guidelines for the Diagnosis,Treatment and Prevention of Pulmonary Thromboembolism and Deep Vein Thrombosis (JCS 2004) h Circulation Journal Vol. 68, Suppl. IV,
2 ACT activated clotting time ADL activity of daily life APC activated protein C APTT activated partial thromboplastin time BMI body mass index CT computed tomography DIC disseminated intravascular coagulopathy DVT deep vein thrombosis ESC European Society of Cardiology FDA Food and Drug Administration HIT heparin-induced thrombocytopenia HOT home oxygen therapy ICOPER International Cooperative Pulmonary Embolism Registry INR international normalized ratio mt-pa mutant tissue-type plasminogen activator PAIMS Plasminogen Activator Italian Multicenter Study PCPS Percutaneous Cardiopulmonary Support PH pulmonary hypertension PIOPED Prospective Investigation of Pulmonary Embolism Diagnosis PT prothrombin time rt-pa recombinant tissue-type plasminogen activator SK streptokinase t-pa tissue-type plasminogen activator MRI magnetic resonance image MRV magnetic resonance venography UK urokinase UPET Urokinase Pulmonary Embolism Trial 1 a b Circulation Journal Vol. 68, Suppl. IV, 2004
3 1 C S C Leiden G20210A * , Virchow % 40 mmhg acute on chronic % % 30 % 2 ESC Goldhaber Massive Massive 90 mmhg 40 mmhg 15 Submassive Moderate to large Non-massive Small to moderate Circulation Journal Vol. 68, Suppl. IV,
4 % 50 % 6 % 30 % 2 8 % % % mmhg QOL % % % C S 43.9 % honeymoon period Circulation Journal Vol. 68, Suppl. IV, 2004
5 5 6 Riedel 30 mmhg % 30 % Homans D- 2 CT MRA a 3 b Circulation Journal Vol. 68, Suppl. IV,
6 No Yes X D- 1 CT MRA 2 PCPS Circulation Journal Vol. 68, Suppl. IV, 2004
7 2 PaO2 60 Torr SpO2 90 % PaO2 60 Torr SpO2 90 % 7 ml Kg NO PCPS 1 2 a a a a PCPS 3 5,000 1,400 17, Xa U ml APTT PT-INR PT-INR APTT APTT ml , , , , , ,840 6 APTT 5,000 1,400 6 APTT APTT ml Circulation Journal Vol. 68, Suppl. IV,
8 t-pa mmhg 110 mmhg 100,000 mm 3 50% EurHeart J 2000; 21: APTT urokinase rt-pa alteplase 2,400 2 mt-pa monteplase 27,500 kg 2 streptokinase urokinase ,400 kg 10 4,400 kg FDA 1978 FDA rt-pa alteplase 100 mg FDA FDA Food and Drug Administration mt-pa mutant tissue-type plasminogen activator rt-pa recombinant tissue-type plasminogen activator 1142 Circulation Journal Vol. 68, Suppl. IV, 2004
9 a 1 b 1 PT-INR pulse-spray 8Fr PTCA 6Fr mm 5Fr pigtail rotation catheter Angiojet Thrombectomy Hydrolyser Oasis Thrombectomy 1 b 2 b b b 5 CT PCPS PCPS Circulation Journal Vol. 68, Suppl. IV,
10 Gray % Meyer % 8 25 % Gulba 23 % % MRSA 1 2 a 6 a b Class a b a Circulation Journal Vol. 68, Suppl. IV, 2004
11 7 1 Hugh-Jones a PaCO2 35 Torr PaO2 70 Torr b AaDO2 AaDO2 30 Torr X a 18 mm b CTR 50% c a P b V1 R 5 mm R S 1 V5 S 7 mm R S 1 a b segmental defects 6 6 a pouch defectsb webs and bandsc intimal irregularitiesd abrupt narrowinge complete obstruction 5 1 a 25 mmhg b12 mmhg 3 4 a1 1 b2 2 c3 a1 1 b2 1 c3 Circulation Journal Vol. 68, Suppl. IV,
12 X 6 a pouch defects b webs and bands c intimal irregularities d abrupt narrowing e complete obstruction mmhg a b c d 1 2 CT 2 1 INR a 2 b 3 b 4 b 5 b Circulation Journal Vol. 68, Suppl. IV, 2004
13 4 5 back flow taping % PaO a CT Daily 300 dyne sec cm 5 Jamieson 1 30 mmhg 300 dyne sec cm NYHA Daily Jamieson San Diego 1 Jamieson % Circulation Journal Vol. 68, Suppl. IV,
14 Swan-Gantz Jamieson SVO2 90 % mmhg PCPS 7 3 PCPS ICU 2 3 PEEP PGE1 PGI2 Daily 11.7 % % Jamieson 8.7 % % Tscholl 10.1 % 7 69Thistlethwaite 6 % % NYHA % % % Circulation Journal Vol. 68, Suppl. IV, 2004
15 3 D- CT 3 D- 4 CT CT 1 D- a b 2 a CT MRV b 2 D mg 100 APTT a 3 PT-INR apt 3.0 PT-INR Class C S Circulation Journal Vol. 68, Suppl. IV,
16 Class 4800 kg kg 1 96 a 3 10 a a 4 b 5 1 a 2 a 3 a 4 a DVT % DVT % PE % PE % DVT deep vein thrombosis PE pulmonary thromboembolism Circulation Journal Vol. 68, Suppl. IV, 2004
17 ,000 APTT 3,500 4 APTT APTT ACT PT-INR PT-INR PT-INR C S 45 Circulation Journal Vol. 68, Suppl. IV,
18 1 2 3 a 4 a 5 a Circulation Journal Vol. 68, Suppl. IV,
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2002 2003 Guidelines for the Diagnosis,Treatment and Prevention of Pulmonary Thromboembolism and Deep Vein Thrombosis (JCS 2004) h 1 2 3 1 1 2 2-1 2-2 2-3 2-4 2-5 2-6 2 1 2 2-1 2-2 3 1 2 4 Circulation
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