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Hamostaseologie 2018; 38(02): 98-105
DOI: 10.1055/s-0038-1641717
Review Article
Schattauer GmbH Stuttgart

Reperfusion Treatment for Acute Pulmonary Embolism

Rolf P. Engelberger
1   Division of Angiology, Cantonal Hospital Fribourg, Fribourg, Switzerland
,
Nils Kucher
2   Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

31 July 2017

17 January 2018

Publication Date:
29 May 2018 (online)

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Abstract

Due to the manifold treatment options for the management of acute pulmonary embolism, state-of-the-art management requires risk stratification for choosing the adapted treatment for each patient. Reperfusion therapy is an integral part of therapy for patients with pulmonary embolism at high risk for mortality, but its role in patients with intermediate risk pulmonary embolism is more debated. The largest amount of evidence exists for systemic thrombolysis, which is an efficient therapy, but at the prize of an increased bleeding risk. In recent years, various types of catheter-based reperfusion therapies have been introduced, and evidence is growing that this therapy is as efficient as systemic thrombolysis, but with a more favourable safety profile. Surgical embolectomy remains a good alternative for unstable patients, especially for those with absolute contraindications for thrombolysis or after failed systemic thrombolysis. While the early benefits of reperfusion therapy are well documented, evidence for long-term benefit is still scarce. The scope of this review is to summarize the evidence for the currently available reperfusion therapies in the management of acute pulmonary embolism.

Zusammenfassung

Aufgrund der vielfältigen Behandlungsmöglichkeiten für die akute Lungenembolie erfordert das Management nach dem neuesten Stand eine Risikostratifizierung, um die angepasste Behandlung für jeden Patienten auszuwählen. Die Reperfusionstherapie ist ein wesentlicher Therapiebestandteil bei Patienten mit Lungenembolie mit hohem Mortalitätsrisiko, aber ihre Rolle bei Patienten mit Intermediärrisiko-Lungenembolie ist umstritten. Die größte Evidenz gibt es für die systemische Thrombolyse, die eine effiziente Therapie darstellt, jedoch zum Preis eines erhöhten Blutungsrisikos. In den letzten Jahren wurden verschiedene Arten von katheter-basierten Reperfusionstherapien eingeführt, und es gibt Hinweise dafür, dass diese Therapie genauso effizient ist wie die systemische Thrombolyse, aber mit einem vorteilhafteren Sicherheitsprofil. Die chirurgische Embolektomie bleibt eine gute Alternative für instabile Patienten, insbesondere für Patienten mit absoluten Kontraindikationen für Thrombolyse oder nach erfolgloser systemischer Thrombolyse. Während die frühen Vorteile der Reperfusionstherapie gut dokumentiert sind, ist der Nachweis für einen langfristigen Nutzen immer noch gering. Ziel dieser Übersichtsarbeit ist es, die Evidenz für die derzeit verfügbaren Reperfusionstherapien bei der Behandlung der akuten Lungenembolie zusammenzufassen.

Keywords

pulmonary embolism - catheter-based therapy - reperfusion therapy - thrombolysis

Schlüsselwörter

Lungenembolie - Katheter-basierte Therapie - Reperfusionstherapie - Thrombolyse
 

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