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Current Approach to Pulmonary Embolism

Yıl 2016, Cilt: 25 Sayı: 4, 550 - 570, 31.12.2016
https://doi.org/10.17827/aktd.253565

Öz

Pulmonary embolism is a relatively common cardiovascular emergency. Pulmonary embolism and deep venous thrombosis constitute one of the ‘big three’ cardiovascular killers along with myocardial infarction and stroke. The case fatality rate for pulmonary embolism exceeds the mortality rate for acute myocardial infarction. Thus, early diagnosis is fundemantal, since immediate treatment is highly effective. However, is pulmonary embolism a difficult diagnosis that might be missed because of non-specific clinical presentation. This review will address the current approach to pulmonary embolism except fot the treatment which will be a subject for a future article.


Kaynakça

  • Güven Platformu. Ulusal Venöz Tromboembolizm Profilaksi ve Tedavi Kılavuzu. 2010
  • White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107:14-8.
  • Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007;98:756-64.
  • Kearon C, Akl EA. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood. 2014;123:1794–1801.
  • Anderson FA Jr., Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107:19- 116.
  • Rogers MA, Levine DA, Blumberg N, Flanders SA, Chopra V, Langa KM. Triggers of hospitalization for venous thromboembolism. Circulation. 2012;125:2092-9.
  • Ku GH, White RH, Chew HK, Harvey DJ, Zhou H,WunT. Venous thromboembolism in patients with acute leukemia: incidence, risk factors, and effect on survival. Blood. 2009;113:3911-7.
  • Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166:458-64.
  • Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293:715-22.
  • Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer associated venous thrombosis. Blood. 2013;122:1712-23.
  • Blanco-Molina A, Rota LL, Di Micco P, Brenner B, Trujillo-Santos J, Ruiz-Gamietea A, et al. Venous thromboembolism during pregnancy, postpartum or during contraceptive use. Thromb Haemost. 2010;103:306-11.
  • Blanco-Molina A, Trujillo-Santos J, Tirado R, Can˜as I, Riera A, Valde´s M, et al. Venous thromboembolism in women using hormonal contraceptives. Findings from the RIETE Registry. Thromb Haemost. 2009;101:478-82.
  • Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost. 2008;6:632-7.
  • Henriksson P, Westerlund E, Walle´n H, Brandt L, HovattaO, Ekbom A. Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study. BMJ. 2013;346:e8632.
  • Sweetland S, Beral V, Balkwill A, Liu B, Benson VS, Canonico M, et al. Venous thromboembolism risk in relation to use of different types of postmenopausal hormone therapy in a large prospective study. J Thromb Haemost. 2012;10:2277-86.
  • Clayton TC, Gaskin M, Meade TW. Recent respiratory infection and risk of venous thromboembolism: case-control study through a general practice database. Int J Epidemiol.
  • Smeeth L, Cook C, Thomas S, Hall AJ, Hubbard R, Vallance P. Risk of deep vein thrombosis and pulmonary embolism after acute infection in a community setting. Lancet. 2006;367:1075-9.
  • Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111:4902-7.
  • Piazza G, Goldhaber SZ. Venous thromboembolism and atherothrombosis: an integrated approach. Circulation. 2010;121:2146-50.
  • Severinsen MT, Kristensen SR, Johnsen SP, Dethlefsen C, Tjonneland A, Overvad K. Smoking and venous thromboembolism: a Danish follow-up study. J Thromb Haemost. 2009;7:1297-303.
  • Steffen LM, Cushman M, Peacock JM, Heckbert SR, Jacobs DR Jr., Rosamond WD et al. Metabolic syndrome and risk of venous thromboembolism: Longitudinal Investigation of Thromboembolism Etiology. J Thromb Haemost. 2009;7:746-51.
  • AgenoW, Becattini C, Brighton T, Selby R, Kamphuisen PW. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation. 2008;117:93-102.
  • Kakkar VV, Howe CT, Flanc C, Clarke MB. Natural history of postoperative deep vein thrombosis. Lancet. 1969;2:230-2.
  • Dalen JE. Pulmonary embolism: what have we learned since Virchow? Natural history, pathophysiology, and diagnosis. Chest. 2002;122:1440-56.
  • Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107:122-30.
  • Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest. 2002;121:877-905.
  • Konstantinides S. Pulmonary embolism: impact of right ventricular dysfunction. Curr Opin Cardiol. 2005;20:496-501.
  • Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J et al. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med. 2006;166:169-75.
  • Laporte S, Mismetti P, De´cousus H, Uresandi F, Otero R, Lobo JL, et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation. 2008;117:1711-16.
  • Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet.1999;353:1386-9.
  • Miniati M, Monti S, Bottai M, Scoscia E, Bauleo C, Tonelli L, et al. Survival and restoration of pulmonary perfusion in a long-term follow-up of patients after acute pulmonary embolism. Medicine. (Baltimore). 2006;85:253-62.
  • Becattini C, Agnelli G, Pesavento R, Silingardi M, Poggio R, Taliani MR et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest.
  • Moser KM, Fedullo PF, Littejohn JK, Crawford R. Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. JAMA. 1994;271:223-5.
  • Kyrle PA, Rosendaal FR, Eichinger S. Risk assessment for recurrent venous thrombosis. Lancet. 2010;376:2032-9.
  • Zhu T, Martinez I, Emmerich J. Venous thromboembolism: risk factors for recurrence. Arterioscler Thromb Vasc Biol. 2009;29:298-310.
  • Heit JA. Predicting the risk of venous thromboembolism recurrence. Am J Hematol. 2012;87:63- 67.
  • Smulders YM. Pathophysiology and treatment of haemodynamic instability in acute pulmonary embolism: the pivotal role of pulmonary vasoconstriction. Cardiovasc Res. 2000;48:23-33.
  • Molloy WD, Lee KY, Girling L, Schick U, Prewitt RM. Treatment of shock in a canine model of pulmonary embolism. Am Rev Respir Dis. 1984;130:870-4.
  • Marcus JT, Gan CT, Zwanenburg JJ, Boonstra A, Allaart CP, Gotte MJ, et al. Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling. J Am Coll Cardiol. 2008;51:750-7.
  • Mauritz GJ, Marcus JT, Westerhof N, Postmus PE, Vonk-Noordegraaf A. Prolonged right ventricular post-systolic isovolumic period in pulmonary arterial hypertension is not a reflection of diastolic dysfunction. Heart. 2011;97:473-8.
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  • Kasper W, Geibel A, Tiede N, Just H. Patent foramen ovale in patients with haemodynamically significant pulmonary embolism. Lancet. 1992;340:561-4.
  • Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N et al. ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society. Eur Heart J. 2014;35:3033-69.
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  • Anderson DR, Kahn SR, Rodger MA, Kovacs MJ, Morris T, Hirsch A et al. Computed tomographic pulmonary angiography vs. ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA. 2007;298:2743-53.
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  • Carrier M, Righini M, Wells PS, Perrier A, Anderson DR, Rodger MA et al. Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies. J Thromb Haemost. 2010;8:1716-22.
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  • Kearon C, Ginsberg JS, Hirsh J. The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism. Ann Intern Med. 1998;129:1044-9.
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  • Correspondence Address / Yazışma Adresi Abdullah Tekin
  • Başkent Üniversitesi Tıp Fakültesi
  • Kardiyoloji Anabilim Dalı, Ankara, Turkey
  • e-mail: tekincardio@yahoo.com
  • Geliş tarihi/ Received: 03.03.2016
  • Kabul tarihi/Accepted: 20.04.2016

Pulmoner Emboliye Güncel Yaklaşım

Yıl 2016, Cilt: 25 Sayı: 4, 550 - 570, 31.12.2016
https://doi.org/10.17827/aktd.253565

Öz

Pulmoner emboli kardiyovasküler acil bir durumdur. Miyokard enfarktüsü ve inme ile birlikte pulmoner
emboli ve derin ven trombozu üç büyük kardiyovasküler ölümcül hastalığı oluşturmaktadır. Pulmoner
emboliye bağlı vaka ölüm oranı miyokard enfarktüsüne bağlı ölüm oranından yüksektir. Dolayısıyla,
erken tanı, erken tedavininde oldukça etkili olması nedeniyle, yaşamsaldır. Bununla birikte hastalığın
özgül olmayan klinik bulguları nedeniyle tanı koymak güçtür ve tanı gözden kaçabilir. Bu derlemede
başka bir makalenin konusu olacak tedavi bölümü hariç pulmoner emboliye güncel yaklaşım
sunulacaktır.

Kaynakça

  • Güven Platformu. Ulusal Venöz Tromboembolizm Profilaksi ve Tedavi Kılavuzu. 2010
  • White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107:14-8.
  • Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007;98:756-64.
  • Kearon C, Akl EA. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood. 2014;123:1794–1801.
  • Anderson FA Jr., Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107:19- 116.
  • Rogers MA, Levine DA, Blumberg N, Flanders SA, Chopra V, Langa KM. Triggers of hospitalization for venous thromboembolism. Circulation. 2012;125:2092-9.
  • Ku GH, White RH, Chew HK, Harvey DJ, Zhou H,WunT. Venous thromboembolism in patients with acute leukemia: incidence, risk factors, and effect on survival. Blood. 2009;113:3911-7.
  • Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166:458-64.
  • Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293:715-22.
  • Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer associated venous thrombosis. Blood. 2013;122:1712-23.
  • Blanco-Molina A, Rota LL, Di Micco P, Brenner B, Trujillo-Santos J, Ruiz-Gamietea A, et al. Venous thromboembolism during pregnancy, postpartum or during contraceptive use. Thromb Haemost. 2010;103:306-11.
  • Blanco-Molina A, Trujillo-Santos J, Tirado R, Can˜as I, Riera A, Valde´s M, et al. Venous thromboembolism in women using hormonal contraceptives. Findings from the RIETE Registry. Thromb Haemost. 2009;101:478-82.
  • Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost. 2008;6:632-7.
  • Henriksson P, Westerlund E, Walle´n H, Brandt L, HovattaO, Ekbom A. Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study. BMJ. 2013;346:e8632.
  • Sweetland S, Beral V, Balkwill A, Liu B, Benson VS, Canonico M, et al. Venous thromboembolism risk in relation to use of different types of postmenopausal hormone therapy in a large prospective study. J Thromb Haemost. 2012;10:2277-86.
  • Clayton TC, Gaskin M, Meade TW. Recent respiratory infection and risk of venous thromboembolism: case-control study through a general practice database. Int J Epidemiol.
  • Smeeth L, Cook C, Thomas S, Hall AJ, Hubbard R, Vallance P. Risk of deep vein thrombosis and pulmonary embolism after acute infection in a community setting. Lancet. 2006;367:1075-9.
  • Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111:4902-7.
  • Piazza G, Goldhaber SZ. Venous thromboembolism and atherothrombosis: an integrated approach. Circulation. 2010;121:2146-50.
  • Severinsen MT, Kristensen SR, Johnsen SP, Dethlefsen C, Tjonneland A, Overvad K. Smoking and venous thromboembolism: a Danish follow-up study. J Thromb Haemost. 2009;7:1297-303.
  • Steffen LM, Cushman M, Peacock JM, Heckbert SR, Jacobs DR Jr., Rosamond WD et al. Metabolic syndrome and risk of venous thromboembolism: Longitudinal Investigation of Thromboembolism Etiology. J Thromb Haemost. 2009;7:746-51.
  • AgenoW, Becattini C, Brighton T, Selby R, Kamphuisen PW. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation. 2008;117:93-102.
  • Kakkar VV, Howe CT, Flanc C, Clarke MB. Natural history of postoperative deep vein thrombosis. Lancet. 1969;2:230-2.
  • Dalen JE. Pulmonary embolism: what have we learned since Virchow? Natural history, pathophysiology, and diagnosis. Chest. 2002;122:1440-56.
  • Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107:122-30.
  • Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest. 2002;121:877-905.
  • Konstantinides S. Pulmonary embolism: impact of right ventricular dysfunction. Curr Opin Cardiol. 2005;20:496-501.
  • Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J et al. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med. 2006;166:169-75.
  • Laporte S, Mismetti P, De´cousus H, Uresandi F, Otero R, Lobo JL, et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation. 2008;117:1711-16.
  • Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet.1999;353:1386-9.
  • Miniati M, Monti S, Bottai M, Scoscia E, Bauleo C, Tonelli L, et al. Survival and restoration of pulmonary perfusion in a long-term follow-up of patients after acute pulmonary embolism. Medicine. (Baltimore). 2006;85:253-62.
  • Becattini C, Agnelli G, Pesavento R, Silingardi M, Poggio R, Taliani MR et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest.
  • Moser KM, Fedullo PF, Littejohn JK, Crawford R. Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. JAMA. 1994;271:223-5.
  • Kyrle PA, Rosendaal FR, Eichinger S. Risk assessment for recurrent venous thrombosis. Lancet. 2010;376:2032-9.
  • Zhu T, Martinez I, Emmerich J. Venous thromboembolism: risk factors for recurrence. Arterioscler Thromb Vasc Biol. 2009;29:298-310.
  • Heit JA. Predicting the risk of venous thromboembolism recurrence. Am J Hematol. 2012;87:63- 67.
  • Smulders YM. Pathophysiology and treatment of haemodynamic instability in acute pulmonary embolism: the pivotal role of pulmonary vasoconstriction. Cardiovasc Res. 2000;48:23-33.
  • Molloy WD, Lee KY, Girling L, Schick U, Prewitt RM. Treatment of shock in a canine model of pulmonary embolism. Am Rev Respir Dis. 1984;130:870-4.
  • Marcus JT, Gan CT, Zwanenburg JJ, Boonstra A, Allaart CP, Gotte MJ, et al. Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling. J Am Coll Cardiol. 2008;51:750-7.
  • Mauritz GJ, Marcus JT, Westerhof N, Postmus PE, Vonk-Noordegraaf A. Prolonged right ventricular post-systolic isovolumic period in pulmonary arterial hypertension is not a reflection of diastolic dysfunction. Heart. 2011;97:473-8.
  • Sergysels R. Pulmonary gas exchange abnormalities in pulmonary embolism. In: Morpurgo M, ed. Pulmonary Embolism. New York: Marcel Dekker, 1994;89-96.
  • Kasper W, Geibel A, Tiede N, Just H. Patent foramen ovale in patients with haemodynamically significant pulmonary embolism. Lancet. 1992;340:561-4.
  • Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N et al. ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society. Eur Heart J. 2014;35:3033-69.
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  • Correspondence Address / Yazışma Adresi Abdullah Tekin
  • Başkent Üniversitesi Tıp Fakültesi
  • Kardiyoloji Anabilim Dalı, Ankara, Turkey
  • e-mail: tekincardio@yahoo.com
  • Geliş tarihi/ Received: 03.03.2016
  • Kabul tarihi/Accepted: 20.04.2016
Toplam 95 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Derleme
Yazarlar

Abdullah Tekin

Yayımlanma Tarihi 31 Aralık 2016
Kabul Tarihi 20 Nisan 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 25 Sayı: 4

Kaynak Göster

AMA Tekin A. Pulmoner Emboliye Güncel Yaklaşım. aktd. Aralık 2016;25(4):550-570. doi:10.17827/aktd.253565