please, remember the new therapeutic approach.
From NAFLD to MAFLD - metabolic associated fatty liver disease
Clinical approach to obesity
Management of cardiovascular risk
2016 European Guidelines on cardiovasculaR disease prevention in clinical practice
CHEST Guideline and Expert Panel Report
BACKGROUND: We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics.
METHODS: We generate strong (Grade 1) and weak (Grade 2) recommendations based on high- (Grade A), moderate- (Grade B), and low- (Grade C) quality evidence.
RESULTS: For VTE and no cancer, as long-term anticoagulant therapy, we suggest dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B), or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over low-molecular-weight heparin (LMWH; Grade 2C). For VTE and cancer, we suggest LMWH over VKA (Grade 2B), dabigatran (Grade 2C), rivaroxaban (Grade 2C), apixaban (Grade 2C), or edoxaban (Grade 2C).
We have not changed recommendations for who should stop anticoagulation at 3 months or receive extended therapy. For VTE treated with anticoagulants, we recommend against an inferior vena cava fiLlter (Grade 1B).
For DVT, we suggest not using compression stockings routinely to prevent PTS (Grade 2B).
For subsegmental pulmonary embolism and no proximal DVT, we suggest clinical surveillance over anticoagulation with a low risk of recurrent VTE (Grade 2C), and anticoagulation over clinical surveillance with a high risk
(Grade 2C).
We suggest thrombolytic therapy for pulmonary embolism with hypotension (Grade 2B), and systemic therapy over catheter-directed thrombolysis (Grade 2C). Forrecurrent VTE on a non-LMWH anticoagulant, we suggest LMWH (Grade 2C); for recurrent VTE on LMWH, we suggest increasing the LMWH dose (Grade 2C).
CONCLUSIONS: Of 54 recommendations included in the 30 statements, 20 were strong and none was based on high-quality evidence, highlighting the need for further research.
CHEST 2016; 149(2):315-352
SEE ATTACHED
Thoracentesis is a valuable diagnostic procedure in a patient with pleural effusion of unknown causation. Analysis of the pleural fluid will allow its categorization as either a transudate (a product of unbalanced hydrostatic forces) or an exudate (a product of increased capillary permeability or lymphatic obstruction) (Table 1). If the effusion seems to have an obvious source (e.g., in an afebrile patient with congestive heart failure and bilateral pleural effusions), diagnostic thoracentesis may be deferred while the underlying process is treated. The need for the procedure should be reconsidered if there is no appropriate response to therapy.1 Thoracentesis, as a therapeutic procedure, may dramatically reduce respiratory distress in patients presenting with large effusions.
