Lungenembolie

Kernaussagen

Die akute LE bleibt auch 40 Jahre nach Einführung der Heparintherapie eine potenziell lebensbedrohliche Erkrankung mit einer Letalität von etwa 10 %. Der kritische Faktor ist die schnelle und sichere Diagnostik. Dabei wird neuerdings der Spiral-CT eine größere Bedeutung beigemessen, die mit der Verbreitung der Multidetectoring-Spiral-CT weiter zunehmen wird.

Die Indikation zur Lysetherapie ist weiterhin auf die massive LE mit instabiler Hämodynamik (sicher) oder echokardiographischer rechtsventrikulärer Dysfunktion (kontrovers) beschränkt. Für die submassive LE ist ein Vorteil der Lysetherapie gegenüber der alleinigen Antikoagulation nicht nachgewiesen. Unter Reanimationsbedingungen ist die Lyse bereits beim Verdacht auf eine LE durchzuführen. Die Lyse sollte grundsätzlich als Bolus- oder Kurzzeitlyse durchgeführt werden, wobei rt-PA bevorzugt wird.

Die aktuellen Leitlinien sind:

European Society of Cardiology: Guidelines on diagnosis and management of acute pulmonary embolism (2000) [26]

Leitlinie der Deutschen Gesellschaft für Angiologie: Diagnostik und Therapie der Venenthrombose und LE (2005) [42]

American Collage of Emergency Physicians: Clinical policy: Critical issues in the evaluation and management of adult patients presenting with suspected pulmonary embolism (2003) [25]

British Thoracic Society: Guidelines for the mangement of suspected acute pulmonary embolism (2003) [1]

Literatur

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