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.
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.
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)
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