Der Pneumologe

, 6:378

Aktuelles Management der akuten Lungenembolie

Leitthema
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Zusammenfassung

Die akute Lungenembolie (LE) ist eine häufige Ursache von Komplikationen und Todesfällen im Zusammenhang mit internistischen Erkrankungen, Operationen und Verletzungen. Das Letalitätsrisiko kann durch frühe, adäquate Behandlung gesenkt werden. Anhand eines auf Anamnese, Befunden und Symptomen basierenden Scores lässt sich die Wahrscheinlichkeit für eine LE festlegen. Bei Patienten mit geringer Vortestwahrscheinlichkeit schließt ein negativer D-Dimer-Test das Vorliegen einer venösen Thromboembolie aus. Das zuverlässigste bildgebende diagnostische Verfahren ist die Multidetektor-Computertomographie (MDCT). Für hämodynamisch stabile LE-Patienten wird eine Antikoagulation mit unfraktioniertem oder niedermolekularem Heparin empfohlen, bei Patienten im (Prä-)Schock führen Thrombolytika zur raschen Auflösung der thromboembolischen Obstruktion und erzielen günstige hämodynamische Effekte. Eine Antikoagulation mit Vitamin-K-Antagonisten oder niedermolekularem Heparin wird zur Rezidivprophylaxe verwendet, die Dauer ist abhängig vom individuellen Risiko.

Schlüsselwörter

Lungenembolie Antikoagulation Thrombolyse 

Management of acute pulmonary embolism

Abstract

Acute pulmonary embolism (PE) is a major cause of complications and deaths associated with medical disorders, surgery, and injuries. The risk of death can be reduced by early and adequate treatment. A score based on history, signs, and symptoms can be used to determine the probability of PE. For patients with a low pretest probability, a negative D-dimer rules out venous thromboembolism. The most reliable imaging procedure for diagnosing PE is multidetector computed tomography. For patients with PE and stable cardiocirculatory conditions, anticoagulation with unfractionated or low-molecular-weight heparin is recommended. For PE patients with preshock or shock, thrombolytic agents rapidly resolve thromboembolic obstruction and have favourable hemodynamic effects. Oral anticoagulation (vitamin K antagonists) or low-molecular-weight heparin are used for prophylaxis of recurrent PE. The duration of this regimen depends on the patient’s individual risk of recurrent PE.

Keywords

Pulmonary embolism Anticoagulation Thrombolysis 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Medizinische Klinik IKlinikum FürthFürthDeutschland

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