Lungenembolie

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. 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, a treatment decision should preferable be made in interdisciplinary “Pulmonary Embolism Response Teams” (PERT). Being comparably efficient and due to a preferable safety profile compared to vitamin-K antagonists (VKAs), non-vitamin K-dependent oral anticoagulants (NOACs) are increasingly considered to be the treatment of choice for initial and prolonged anticoagulation of patients with pulmonary embolism. The 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 thus should be considered for all patients with unprovoked events.

In diesem Übersichtsartikel werden aktuelle Empfehlungen internationaler Leitlinien und die neuesten Erkenntnisse zur Diagnose, Risikostratifizierung, medikamentösen und Katheter-gestützten 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.

Schlüsselwörter

Lungenembolie - Risikostratifizierung - Thrombolyse - Antikoagulation - Prognose - Dyspnoe

Key words

pulmonary embolism - risk stratification - thrombolysis - anticoagulation - prognosis

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