In diesem Übersichtsartikel werden aktuelle Empfehlungen internationaler Leitlinien
sowie die neuesten Erkenntnisse zur Diagnose, Risikostratifizierung, medikamentösen
und kathetergestützten Reperfusionsbehandlung sowie der initialen und langfristigen
Antikoagulation unter Berücksichtigung des individuellen Rezidiv- und Blutungsrisikos
bei Patienten mit Lungenembolie zusammengefasst, durch klinische Fallbeispiele begleitet
und kritisch diskutiert.
Abstract
Pulmonary embolism (PE) is a life-threatening disease and the third most frequent
cardiovascular cause of death after stroke and myocardial infarction. The annual incidence
is increasing (in Germany from 85 cases per 100000 population in the year 2005 to
109 cases per 100000 population in the year 2015). The individual risk for PE-related
complications and death increases with the number of comorbidities and severity of
right ventricular dysfunction. Using clinical, laboratory and imaging parameters,
patients with PE can be stratified to four risk classes (high, intermediate-high,
intermediate-low and low risk). This risk stratification has concrete therapeutic
consequences ranging from out-of-hospital treatment of low-risk patients to reperfusion
treatment of (intermediate)-high-risk patients. For haemodynamically unstable patients,
treatment decision should preferably be made in interdisciplinary “Pulmonary Embolism
Response Teams” (PERT). Due to their comparable efficacy and preferable safety profile
compared to vitamin-K antagonists (VKAs), non-vitamin K-dependent oral anticoagulants
(NOACs) are increasingly considered the treatment of choice for initial and prolonged
anticoagulation of patients with pulmonary embolism. Use of low molecular weight heparins
(LMWHs) is recommended for PE patients with cancer; however, recent studies indicate
that treatment with factor Xa-inhibitors may be effective and safe (in patients without
gastrointestinal cancer). Only prolonged anticoagulation (in reduced dosage) will
ensure reduction of VTE recurrence and should thus be considered for all patients
with unprovoked events.
Schlüsselwörter
Lungenembolie - Risikostratifizierung - Thrombolyse - Antikoagulation - Dyspnoe
Keywords
pulmonary embolism - risk stratification - thrombolysis - anticoagulation
