Lungenembolie auf der Intensivstation

Kernaussagen

• Hochrisikopatienten mit Lungenembolie sind hämodynamisch instabil und sollten umgehend einer pulmonalen Rekanalisierung zugeführt werden, um die hohe Letalität zu reduzieren.

• Therapie der Wahl ist in der Regel eine systemische Thrombolyse, alternativ sollte man eine chirurgische Embolektomie anstreben.

• Auch Intermediärrisiko-Patienten mit akuter Rechtsherzbelastung und einer Erhöhung der myokardialen Nekroseparameter profitieren von einer Lyse, wenn sie jünger als 75 Jahre sind, ein niedriges Blutungsrisiko haben und keine Kontraindikationen vorliegen.

• Zentraler Pfeiler der Lungenembolietherapie ist die sofortige plasmatische Antikoagulation in therapeutischer Dosierung.

• Neu zugelassen sind für Therapie und Sekundärprophylaxe die DOAK Rivaroxaban, Dabigatran und Apixaban, die ähnlich effektiv Rezidive einer venösen Thromboembolie verhindern, aber weniger Blutungskomplikationen verursachen als Vitamin-K-Antagonisten.

• Literatur

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