Diagnostik der rezidivierenden Beinvenenthrombose und Lungenembolie

Zusammenfassung

Die venöse Thromboembolie ist eine chronische Erkrankung mit einem fortdauernden Risiko für ein Rezidiv. Tritt ein Rezidiv ein, sind Prognose und Behandlung des Patienten deutlich verändert, wobei beide ihre spezifischen Risiken nicht nur in der Akutphase, sondern besonders im Langzeitverlauf haben. Daher ist die korrekte Diagnose eines Rezidivs von größter Bedeutung. Die Diagnose einer ersten Episode folgt gut fundierten Algorithmen, deren Elemente die klinische Vortestwahrscheinlichkeit, der D-Dimer-Test und der Kompressionsultraschall der Beinvenen darstellen. Die Effizienz aller 3 Elemente ist bei einem Patienten mit Verdacht auf Rezidiv durch die vorhergehende Episode verschlechtert. Die vorliegende Übersicht fasst zusammen, was über die einzelnen diagnostischen Werkzeuge bekannt ist. Es stellt sich heraus, dass der für eine erste Episode gültige Algorithmus auch bei der Diagnose des Rezidivs verwendet werden kann, wenn man sich der schlechteren Effizienz bewusst ist.

Abstract

Venous thromboembolism is a chronic disease with a continuing risk of recurrence. In a patient with recurrence long-term prognosis and treatment are significantly altered both carrying their own risks not only in the acute phase but mainly in the long term perspective. Thus, accurate diagnosis of recurrence is of utmost importance for the fate of the patient. Diagnosis of a first VTE episode is well established and follows an algorithm including clinical prediction rules, D-Dimer testing and compression ultrasound. Due to the previous episode the efficiency of all three elements is impaired in a patient with suspected recurrence. The present review summarizes what is known about the performance of tools for VTE diagnosis, and gives personally weighed recommendations how to deal with this peculiar diagnostic situation. It turns out that the well accepted diagnostic algorithm for a first VTE may be applied as well if the lower efficiency is regarded.

Schlüsselwörter

Beinvenenthrombose - Lungenembolie - Rezidiv - klinische Vortestwahrscheinlichkeit - D-Dimer-Test - Kompressionssonografie - CT-Pulmonalisangiografie

Key words

deep vein thrombosis - pulmonary embolism - recurrence - clinical pretest probability - D-Dimer - venous ultrasound - CT angiography

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