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
