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Neues zu Thrombolyse und Thrombektomie bei Lungenembolie

New aspects of thrombolysis and thrombectomy in pulmonary embolism

Herz volume 44, pages 324–329 (2019)Cite this article

Zusammenfassung

Die Lungenembolie ist eine potenziell lebensbedrohliche Erkrankung, die unterschiedlich schwer verlaufen kann. Anhand einer notfallmäßigen Risikostratifizierung wird die Therapie der Lungenembolie gesteuert. Kann bei geringem Risiko eine ambulante Behandlung erfolgen, muss bei hohem Mortalitätsrisiko eine rasche Rekanalisation angestrebt werden, in aller Regel mittels Thrombolyse oder Thrombektomie. Die systemische Thrombolyse ist dabei bislang das Mittel der Wahl, sofern keine Kontraindikationen vorliegen. Die Dosierung (niedrige vs. volle Dosierung) und Applikation (systemisch vs. lokal über einen Katheter) der zur Lyse am häufigsten eingesetzten Alteplase wird in Studien überprüft mit dem Ziel, das Blutungsrisiko zu senken. Falls Kontraindikationen für eine Thrombolyse vorliegen, ist primär die chirurgische oder sekundär die interventionelle Thrombektomie anzustreben. In diesem Artikel werden diese Verfahren und die verfügbare Literatur besprochen.

Abstract

Pulmonary embolism is a potentially life-threatening disease, which can present with varying severity. Based on an emergency risk stratification, the initial treatment strategy should be chosen without delay. While patients with a low mortality risk can be treated in an outpatient setting, patients at high risk should proceed to immediate recanalization by thrombolysis or thrombectomy. Systemic thrombolysis is the first line therapy in the absence of contraindications. The dosing (low versus full dose) and application (systemic versus local via a catheter) of alteplase, the most frequently used agent, is the subject of a number of current studies with the goal to reduce the risk of bleeding. In the case of contraindications for systemic thrombolysis surgical or alternatively, interventional thrombectomy should be performed. This article discusses these procedures in the light of the currently available literature.

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Affiliations

  1. Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg – Bad Krozingen, Hugstetter Str. 55, 79106, Freiburg, Deutschland

    N. Gauchel, C. Bode & D. Duerschmied

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  1. N. Gauchel
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  2. C. Bode
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  3. D. Duerschmied
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Correspondence to N. Gauchel.

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N. Gauchel, C. Bode und D. Duerschmied geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Gauchel, N., Bode, C. & Duerschmied, D. Neues zu Thrombolyse und Thrombektomie bei Lungenembolie. Herz 44, 324–329 (2019). https://doi.org/10.1007/s00059-019-4801-z

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Schlüsselwörter

  • Lungenarterie
  • Thrombus
  • Rekanalisation
  • Antikoagulation
  • Gewebeplasmoinogenaktivator

Keywords

  • Pulmonary artery
  • Thrombus
  • Recanalization
  • Anticoagulation
  • Tissue plasminogen activator