Lungenembolie: ambulante Therapie und Nachsorge

Trotz sinkender Fallzahlen ist die Lungenembolie nach wie vor eine häufige Todesursache, insbesondere bei älteren Menschen. Im Mittelpunkt der aktuellen Leitlinien stehen die schnelle Risikoeinschätzung bei Verdacht auf eine Lungenembolie sowie die geeignete Therapie. Die Beurteilung, welche Patienten für eine ambulante Behandlung geeignet sind, sowie die passende Nachsorgestrategie werden im Folgenden erörtert.

Abstract

Despite declining numbers – older people in particular – often die from pulmonary embolism. A rapid assessment of the risk in the event of a suspected embolism, the exclusion of comorbidities and the appropriate therapy are the focus of the current guidelines. Early and subsequent outpatient treatment of a patient with acute PE generally requires 3 criteria: low risk of early complications, the absence of serious comorbidities and the highest possible safety at home and, in the event of a complication, rapid access to acute care in the hospital. For patients with a high risk of VTE recurrence, the long-term dosage of secondary drug prophylaxis is not yet clear – studies are currently underway. In patients at moderate risk of VTE recurrence, low-dose secondary prophylaxis can be used to reduce the risk of bleeding. Outpatient pulmonary embolism follow-up care is becoming increasingly important, because studies have shown several times that serious long-term consequences can occur. In pulmonary embolism patients with persistent dyspnea, reduced performance or risk of CTEPH, an outpatient evaluation of the right ventricle using echocardiography, if necessary, in combination with the determination of natriuretic peptides or spiroergometry, is recommended.

Kernaussagen

• Eine frühzeitige und anschließende ambulante Behandlung eines Patienten mit akuter LE erfordert grundsätzlich 3 Kriterien: niedriges Risiko für frühe Komplikationen, das Fehlen schwerer Komorbiditäten und die höchstmögliche Sicherheit zu Hause, und im Falle einer Komplikation schnellen Zugang zur Akutversorgung im Krankenhaus.

• Bei Patienten mit hohem Rezidivrisiko für eine VTE ist die langfristige Dosierung der medikamentösen Sekundärprophylaxe noch nicht abschließend geklärt – derzeitige noch einschließende Studie stehen noch aus.

• Bei Patienten mit moderatem Rezidivrisiko für eine VTE kann eine Sekundärprophylaxe in Niedrigdosis durchgeführt werden, um das Blutungsrisiko zu reduzieren.

• Die ambulante Nachsorge einer Lungenembolie gewinnt an Bedeutung, da mehrfach in Studien gezeigt wurde, dass schwere Langzeitfolgen auftreten können.

• Bei Lungenembolie-Patienten mit persistierender Dyspnoe, Leistungsminderung oder Risiko für eine CTEPH ist eine ambulante Evaluation des rechten Ventrikels mittels Echokardiografie, ggf. in Kombination mit der Bestimmung natriuretischer Peptide oder einer Spiroergometrie, zu empfehlen.

Schlüsselwörter

Lungenembolie - stationäre Behandlung - ambulante Behandlung - Nachsorge - Rezidivrisiko - Antikoagulation

Keywords

pulmonary embolism - inpatient treatment - outpatient treatment - aftercare - risk of recurrence - anticoagulation

Publication History

Article published online:
23 September 2024

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