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Hamostaseologie 2008; 28(01/02): 40-43
DOI: 10.1055/s-0037-1616920
Original Article
Schattauer GmbH

Pulmonary embolism

Lungenembolie
M. Humenberger
1   Department of Cardiology, Medical University of Vienna, Austria
,
I. M. Lang
1   Department of Cardiology, Medical University of Vienna, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
29 December 2017 (online)

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Zusammenfassung

Die akute Pulmonalembolie ist Teil des Spektrums venöser Thromboembolien. Die tiefe Beinvenenthrombose, der akute Thrombus in Transit durch das rechte Herz, die akute Pulmonalembolie selbst und die chronisch thromboembolische pulmonale Hypertension (CTEPH) gehören dazu. Pulmonalembolie kann rezidivieren und schwere Spätfolgen (z. B. postthrombotisches Syndrom, CTEPH) nach sich ziehen.

Diese Übersicht fasst aktuelle Konzepte zur Pathophysiologie, Epidemiologie, Diagnose und Therapie dieser häufigen Erkrankung zusammen.

Summary

The underlying disorder of pulmonary embolism (PE) is venous thromboembolism (VTE), comprising deep vein thrombosis, thrombus in transit, acute pulmonary embolism and chronic thromboembolic pulmonary hypertension (CTEPH). PE may recur and cause serious long-term complications, such as post-thrombotic syndrome and CTEPH. This short overview summarizes current concepts on pathophysiology, epidemiology, diagnosis and treatment of this common disorder.

Schlüsselwörter

Thromboembolismus - Lungenembolie

Keywords

Pulmonary embolism - venous thromboembolism
 

  • References

  • 1 Piazza G, Goldhaber SZ. Acute pulmonary embolism: part I: epidemiology and diagnosis. Circulation 2006; 114: e28-32.
    CrossrefPubMedGoogle Scholar
  • 2 Heit JA. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thromb Thrombolysis 2006; 21: 23-29.
    CrossrefPubMedGoogle Scholar
  • 3 Silverstein MD, Heit JA, Mohr DN. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158: 585-593.
    CrossrefPubMedGoogle Scholar
  • 4 Cushman M, Tsai AW, White RH. et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004; 117: 19-25.
    CrossrefPubMedGoogle Scholar
  • 5 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353: 1386-1389.
    CrossrefPubMedGoogle Scholar
  • 6 Jiang LB, Ying KJ. The impact of right ventricular dysfunction on the clinical outcome of normotensive patients with pulmonary embolism. Zhonghua Nei Ke Za Zhi 2007; 46: 111-113.
    PubMedGoogle Scholar
  • 7 Huerta C, Johansson S, Wallander MA. et al. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med 2007; 167: 935-943.
    CrossrefPubMedGoogle Scholar
  • 8 Goldhaber SZ, Elliott CG. Acute pulmonary embolism: part I: epidemiology, pathophysiology, and diagnosis. Circulation 2003; 108: 2726-2729.
    CrossrefPubMedGoogle Scholar
  • 9 Wells PS. Integrated strategies for the diagnosis of venous thromboembolism. J Thromb Haemost 2007; 5 (Suppl. 01) 41-50.
    CrossrefPubMedGoogle Scholar
  • 10 Stein PD, Fowler SE, Goodman LR. et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006; 354: 2317-2327.
    CrossrefPubMedGoogle Scholar
  • 11 Quiroz R, Kucher N, Zou KH. et al. Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review. JAMA 2005; 293: 2012-2017.
    CrossrefPubMedGoogle Scholar
  • 12 The PIOPED Investigators.. Value of the ventilation/ perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990; 263: 2753-2759.
    CrossrefPubMedGoogle Scholar
  • 13 Kucher N, Goldhaber SZ. Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism. Circulation 2003; 108: 2191-2194.
    CrossrefPubMedGoogle Scholar
  • 14 McDonagh TA, Robb SD, Murdoch DR. et al. Biochemical detection of left-ventricular systolic dysfunction. Lancet 1998; 351: 9-13.
    CrossrefPubMedGoogle Scholar
  • 15 Yardan T, Altintop L, Baydin A. et al. B-type natriuretic peptide as an indicator of right ventricular dysfunction in acute pulmonary embolism. Int J Clin Pract. 2007 in press.
    PubMedGoogle Scholar
  • 16 Tulevski II, ten Wolde M, van Veldhuisen DJ. et al. Combined utility of brain natriuretic peptide and cardiac troponin T may improve rapid triage and risk stratification in normotensive patients with pulmonary embolism. Int J Cardiol 2007; 116: 161-166.
    CrossrefPubMedGoogle Scholar
  • 17 Puls M, Dellas C, Lankeit M. et al. Heart-type fatty acid-binding protein permits early risk stratification of pulmonary embolism. Eur Heart J 2007; 28: 224-229.
    PubMedGoogle Scholar
  • 18 Goekoop RJ, Steeghs N, Niessen RW. et al. Simple and safe exclusion of pulmonary embolism in outpatients using quantitative D-dimer and Wells’ simplified decision rule. Thromb Haemost 97: 146-150.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Van Belle A, Buller HR, Huisman MV. et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006; 295: 172-179.
    CrossrefPubMedGoogle Scholar
  • 20 Simonneau G, Sors H, Charbonnier B. et al. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l‘Embolie Pulmonaire. N Engl J Med 1997; 337: 663-669.
    CrossrefPubMedGoogle Scholar
  • 21 Buller HR, Davidson BL, Decousus H. et al. Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. N Engl J Med 2003; 349: 1695-1702.
    CrossrefPubMedGoogle Scholar
  • 22 Piazza G, Goldhaber SZ. Acute pulmonary embolism: part II: treatment and prophylaxis. Circulation 2006; 114: e42-47.
    CrossrefPubMedGoogle Scholar
  • 23 Konstantinides S. Pulmonary embolism: impact of right ventricular dysfunction. Curr Opin Cardiol 2005; 20: 496-501.
    CrossrefPubMedGoogle Scholar
  • 24 Worster A, Smith C, Silver S. et al. Evidence-based emergency medicine/critically appraised topic. Thrombolytic therapy for submassive pulmonary embolism? Ann Emerg Med 2007; 50: 78-84.
    PubMedGoogle Scholar
  • 25 Konstantinides S, Geibel A, Heusel G. et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism; Heart-type fatty acid-binding protein permits early risk stratification of pulmonary embolism. N Engl J Med 2002; 347: 1143-1150.
    CrossrefPubMedGoogle Scholar
  • 26 Buller HR, Agnelli G, Hull RD. et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (Suppl. 03) 401S-428S.
    CrossrefPubMedGoogle Scholar
  • 27 Wan S, Quinlan DJ, Agnelli G. et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation 2004; 110: 744-749.
    CrossrefPubMedGoogle Scholar
  • 28 Dong B, Jirong Y, Liu G. et al. Thrombolytic therapy for pulmonary embolism. Cochrane Database Syst Rev 2006; CD004437.
    PubMedGoogle Scholar
  • 29 Aklog L, Williams CS, Byrne JG. et al. Acute pulmonary embolectomy: a contemporary approach. Circulation 2002; 105: 1416-1419.
    CrossrefPubMedGoogle Scholar
  • 30 Uflacker R. Interventional therapy for pulmonary embolism. JVasc Interv Radiol 2001; 12: 147-164.
    PubMedGoogle Scholar
  • 31 Kucher N. Catheter embolectomy for acute pulmonary embolism. Chest 2007; 132: 657-663.
    CrossrefPubMedGoogle Scholar
  • 32 Decousus H, Leizorovicz A, Parent F. et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d‘Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 1998; 338: 409-415.
    CrossrefPubMedGoogle Scholar
  • 33 Kucher N, Rossi E, De Rosa M. et al. Massive pulmonary embolism. Circulation 2006; 113: 577-582.
    CrossrefPubMedGoogle Scholar
  • 34 Millward SF, Oliva VL, Bell SD. et al. Gunther Tulip Retrievable Vena Cava Filter: results from the Registry of the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2001; 12: 1053-1058.
    CrossrefPubMedGoogle Scholar
  • 35 Bergqvist D, Agnelli G, Cohen AT. et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002; 346: 975-980.
    CrossrefPubMedGoogle Scholar
  • 36 Eikelboom JW, Quinlan DJ, Douketis JD. Extended- duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials. Lancet 2001; 358: 9-15.
    CrossrefPubMedGoogle Scholar
  • 37 Hull RD, Pineo GF, Stein PD. et al. Extended outof- hospital low-molecular-weight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: a systematic review. Ann Intern Med 2001; 135: 858-869.
    CrossrefPubMedGoogle Scholar
  • 38 Urbankova J, Quiroz R, Kucher N. et al. Intermittent pneumatic compression and deep vein thrombosis prevention. A meta-analysis in postoperative patients. Thromb Haemost 2005; 94: 1181-1185.
    Article in Thieme ConnectPubMedGoogle Scholar