Hestia基準に関して

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Photo by Annie Spratt on Unsplash

はじめに

Hestia基準(Hestia criteria)は外来で肺血栓塞栓症の治療を可能という判断基準。一つでも満たせば、外来での治療はしてはいけない。2011年にオランダのW ZondagらによってJ Thromb Haemostで根拠となる研究が発表された。2019年に改訂されたESC/ERSの急性PE診療ガイドラインでも採用されています。

Hestia基準

  • Hemodynamically unstable*1
  • Thrombolysis or embolectomy needed
  • Active bleeding or high risk for bleeding*2
  • >24 hrs on supplemental oxygen required to maintain SaO2 >90%
  • PE diagnosed while on anticoagulation
  • Severe pain needing IV pain medication required >24 hr
  • Medical or social reason for admission >24 hr (infection, malignancy, no support system)
  • Creatinine clearance <30 mL/min by Cockcroft-Gault formula
  • Severe liver impairment*3
  • Pregnant
  • Documented history of heparin-induced thrombocytopenia (HIT)

*1 sBP <100 mmHg and HR >100, needing ICU care, or by clinician judgment.
*2 GI bleeding or surgery within 2 weeks, stroke within 1 month, bleeding disorder or thrombocytopenia (platelet count <75 × 109/L), uncontrolled HTN (sBP >180 or dBP >110), or by clinician judgment.
*3 By clinician judgment.

参考

Zondag W, Mos IC, Creemers-schild D, et al. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost. 2011;9(8):1500-7.

Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study
Summary. Background: Traditionally, patients with pulmonary embolism (PE) are initially treated in the hospital with low molecular weight heparin (LMWH). The ...

Zondag W, Vingerhoets, LMA, Durian MF, et al. Hestia criteria can safely select patients with pulmonary embolism for outpatient treatment irrespective of right ventricular function. J Thromb Haemost. 2013;11(4): 686– 92.

Hestia criteria can safely select patients with pulmonary embolism for outpatient treatment irrespective of right ventricular function
Background There has been debate over how patients with pulmonary embolism (PE) can be safely selected for outpatient treatment. Objectives To compare the He...

Zondag W, den Exter PL, Crobach MJ, et al. Comparison of two methods for selection of out of hospital treatment in patients with acute pulmonary embolism. Thromb Haemost. 2013;109(1):47-52.

https://em.osumc.edu/education/journalClub/PESIvsHESTIAforoutptPE2012.pdf


Pulmonary Embolism: From Acute PE to Chronic Complications (Respiratory Medicine) (English Edition)

Amazon.co.jp: Pulmonary Embolism: From Acute PE to Chronic Complications (Respiratory Medicine) (English Edition) 電子書籍: Rivera-Lebron, Belinda, Heresi, Gustavo A.: Kindleストア
Amazon.co.jp: Pulmonary Embolism: From Acute PE to Chronic Complications (Respiratory Medicine) (English Edition) 電子書籍: Rivera-Lebron, Belinda, Heresi, Gustavo ...

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