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Kardiologie up2date 2015; 11(02): 95-108
DOI: 10.1055/s-0034-1392569
Kardiovaskuläre Notfälle
© Georg Thieme Verlag KG Stuttgart · New York

Risikoadaptiertes Management der Lungenembolie

Simone Wärntges
,
Stavros V. Konstantinides
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Publication History

Publication Date:
24 July 2015 (online)

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Abstract

Acute pulmonary embolism represents one of the two clinical manifestations of venous thromboembolism and constitutes the third most frequent acute cardiovascular disease with increasing incidence in the ageing population. In the past years, significant progress was made in diagnostic modalities and risk stratification tools as well as in the treatment (i. e. anticoagulation and reperfusion) options. The recently updated pulmonary embolism guidelines of the European Society of Cardiology offer an integrated risk-adjusted approach to pulmonary embolism and may help to optimize treatment and prognosis of the disease, both in the acute phase and over the long term.

Kernaussagen

  • Bereits beim klinischen Verdacht auf eine akute Lungenembolie ist die Initiierung der Antikoagulation indiziert.

  • Die Therapie der akuten LE richtet sich nach der Einschätzung des Mortalitätsrisikos. Als erster Schritt des Management-Algorithmus wird das Vorhandensein eines Schocks bzw. einer persistierenden arteriellen Hypotonie beurteilt.

  • Die Hochrisiko-LE (Schock oder persistierende Hypotonie bei Aufnahme) erfordert eine sofortige Reperfusionstherapie mittels Fibrinolyse oder – im Fall von Kontraindikationen oder Therapieversagen – eine operative bzw. kathetergestützte Thrombusentfernung.

  • Die Nicht-Hochrisiko-LE (kein Schock oder Hypotonie) wird durch klinische Parameter sowie bildgebende und laborchemische Untersuchungen weiter unterteilt und entsprechend der Risikoeinschätzung stationär mit Überwachung oder ggf. ambulant behandelt.

  • Die Fortsetzung der Antikoagulation über die ersten 3 Monate hinaus ist abhängig von den begleitenden Risikofaktoren für ein thromboembolisches Rezidiv.

 

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