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 Journal Vol. 68, Suppl. IV, 2004 1135
2002 2003 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 2002 4 1 1 1136 Circulation Journal Vol. 68, Suppl. IV, 2004
1 C S C Leiden G20210A * 10 2.8 1996 1 3,492 100 28 100 500 18 1 60 70 2 1 Virchow 3 1 2 3 3 3 4 90 % 40 mmhg acute on chronic 10 15 % 5 2 6 14 % 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, 2004 1137
2002 2003 20 % 50 % 6 % 30 % 2 8 % 70 3.7 % 0.1 0.5 % 2 1 6 30 mmhg QOL 2 1 10 50 60 0.1 0.5 % 1997 1997 450 95 % 360 530 1 1.7 3 62 13 21 88 1998 3 28 % C S 43.9 % honeymoon period 4 1138 Circulation Journal Vol. 68, Suppl. IV, 2004
5 6 Riedel 30 mmhg 3 1 2 1 5 3 40 % 30 % 1 1 1 2 Homans 3 1 1 D- 2 CT MRA a 3 b 2 1 12 3 Circulation Journal Vol. 68, Suppl. IV, 2004 1139
2002 2003 1 No Yes X D- 1 CT MRA 2 PCPS 2 1140 Circulation Journal Vol. 68, Suppl. IV, 2004
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 17,500 1 2 Xa 0.3 0.7 U ml APTT 1.5 2.5 3 PT-INR 2.0 3.0 PT-INR 1.5 2.5 4 3 APTT APTT ml 24 50 5,000 0 3 2,880 6 50 59 0 0 3 2,880 6 60 85 0 0 0 0 86 95 0 0 2 1,920 96 120 0 30 2 1,920 6 120 0 60 4 3,840 6 APTT 5,000 1,400 6 APTT APTT 1.9 2.7 40 ml Circulation Journal Vol. 68, Suppl. IV, 2004 1141
2002 2003 4 3 6 t-pa 5 10 2 10 15 1 180 mmhg 110 mmhg 100,000 mm 3 50% EurHeart J 2000; 21: 1301-1336 5 6 14 1 2 3 1 APTT 1.5 2.5 2 3 6 3 6 urokinase 24 96 rt-pa alteplase 2,400 2 mt-pa monteplase 27,500 kg 2 streptokinase urokinase 25 30 10 24 4,400 kg 10 4,400 kg 12 24 1977 FDA 1978 FDA rt-pa alteplase 100 mg 2 1990 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
a 1 b 1 PT-INR 1.5 2.5 4 pulse-spray 8Fr PTCA 6Fr 12 16 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, 2004 1143
2002 2003 Gray 71 29.6 % Meyer 96 37.5 % 8 25 % Gulba 23 % 16 25 % 2003 11 16 28 81 56 7 9 3 4 1 1 2 5 10 12 8 2 6 10 16 11 1 2 2 MRSA 1 2 a 6 a b Class a b a 2 1 7 1144 Circulation Journal Vol. 68, Suppl. IV, 2004
7 1 Hugh-Jones 3 1 1 2 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, 2004 1145
2002 2003 7 X 6 a pouch defects b webs and bands c intimal irregularities d abrupt narrowing e complete obstruction 5 1 25 mmhg a b c d 1 2 CT 2 1 INR 1.5 2.5 1 a 2 b 3 b 4 b 5 b 2 1146 Circulation Journal Vol. 68, Suppl. IV, 2004
4 5 back flow taping 5 1986 16 2 2 12.5 % PaO2 6 3 4220 1891 1173 2 1 a CT Daily 300 dyne sec cm 5 Jamieson 1 30 mmhg 300 dyne sec cm 5 2 3 NYHA Daily Jamieson San Diego 1 Jamieson 15 90 % 10 2 1 Circulation Journal Vol. 68, Suppl. IV, 2004 1147
2002 2003 Swan-Gantz 2 2 3 4 18 Jamieson 15 10 SVO2 90 % 5 6 30 mmhg PCPS 7 3 PCPS ICU 2 3 PEEP PGE1 PGI2 Daily 11.7 % 12 10312.6 % 16 127Jamieson 8.7 % 13 1501990 357 5.1 % Tscholl 10.1 % 7 69Thistlethwaite 6 % 66 1100 55 3 5.5 % 2003 4 75 21 75 54 2 NYHA3 17 23 % 41 55 % 71 4 3 71 5 7.0 % 67 4 63 3 1 1 3 2 1148 Circulation Journal Vol. 68, Suppl. IV, 2004
3 D- CT 3 D- 4 CT CT 1 D- a b 2 a CT MRV b 2 D- 1 60 1 mg 100 APTT 1.5 2.0 5 10 a 3 PT-INR 2.0 3.0 apt 3.0 PT-INR 1.5 2.0 3 6 Class C S 2 1 2 7 3 Circulation Journal Vol. 68, Suppl. IV, 2004 1149
2002 2003 Class 4800 kg 1 6 1200 kg 1 96 a 3 10 a a 4 b 5 1 a 2 a 3 a 4 a 5 4 1 4 8 9 2 8 DVT % DVT % PE % PE % 2 0.4 0.2 0.002 10 20 2 4 1 2 0.1 0.4 20 40 4 8 2 4 0.4 1.0 40 80 10 20 4 10 0.2 5 DVT deep vein thrombosis PE pulmonary thromboembolism. 1150 Circulation Journal Vol. 68, Suppl. IV, 2004
9 8 12 5,000 APTT 3,500 4 APTT 8 500 APTT ACT PT-INR PT-INR 2.0 2.5 PT-INR 1.5 2.5 3 10 45 10 60 40 60 40 40 C S 45 Circulation Journal Vol. 68, Suppl. IV, 2004 1151
1 2 3 a 4 a 5 a Circulation Journal Vol. 68, Suppl. IV, 2004 1152 2002 2003