Enfoque del tromboembolismo pulmonar agudo desde el momento inicial en el servicio de urgencias
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El tromboembolismo pulmonar es la manifestación más grave de la enfermedad tromboembólica venosa y la tercera causa de mortalidad cardiovascular. Su sintomatología puede ir desde un cuadro asintomático o con síntomas leves, hasta el paro cardiaco. Dentro del enfoque de esta patología es importante tener en cuenta escalas que permiten estimar la probabilidad de que determinado paciente con ciertos signos, síntomas y factores de riesgo presente un tromboembolismo pulmonar, así como escalas diseñadas para valorar el riesgo de morir, en pacientes en los que ya se estableció este diagnóstico. Los pilares del tratamiento son la anticoagulación y la trombólisis, sin embargo, esta última está indicada únicamente en algunos casos. La presente revisión tiene como objetivo presentar una actualización de la evidencia sobre el enfoque diagnóstico y terapéutico del tromboembolismo pulmonar agudo, desde el ingreso del paciente al servicio de urgencias.
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Lambrini K, Konstantinos K, Christos I, Petros O, Areti T. Pulmonary embolism: A literature review. Am J Nurs Sci 2017;7:57-66.
Marti C, John G, Konstantinides S, Combescure C, Sánchez O, Lankeit M, et al. Systemic thrombolytic therapy for acute pulmonary embolism: A systematic review and meta-analysis. Eur Heart J 2015;36:605-14.
Xu Q, Huang K, Zhai Z, Yang Y, Wang J, Wang C. Initial thrombolysis treatment compared with anticoagulation for acute intermediate-risk pulmonary embolism: A meta-analysis. J Thorac Dis 2015;7:810-21.
Raskob G. Thrombosis: A major contributor to global disease burden. Thromb Haemost 2014;112:843-52.
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing G-J, Harjola V-P, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2020;41:543-603.
Brækkan SK, Grosse SD, Okoroh EM, Tsai J, Cannegieter SC, Næss IA, et al. Venous thromboembolism, and subsequent permanent work-related disability. J Thromb Haemost 2016;14:1978-87.
Righini M, Gal GL, Aujesky D, Roy P-M, Sánchez O, Verschuren F, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet 2008;371:1343-52.
Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998;129:997-1005.
Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber Z., et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension. Circulation 2011;123:1788-830.
Le Gal G, Righini M, Roy P-M, Sánchez O, Aujesky D, Bounameaux H, et al. Prediction of pulmonary embolism in the emergency department: The Revised Geneva Score. Ann Intern Med 2006;144:165-71.
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease. Chest 2012;141:e419S-96S.
Pollack CV, Schreiber D, Goldhaber SZ, Slattery D, Fanikos J, O’Neil BJ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: Initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real-World Registry). J Am Coll Cardiol 2011;57:700-6.
Tapson VF. Acute pulmonary embolism. N Engl J Med 2009;358:1037-52.
Goldhaber SZ. Risk factors for venous thromboembolism. J Am Coll Cardiol 2010;56:1-7.
Becattini C, Cohen AT, Agnelli G, Howard L, Castejón B, Trujillo-Santos J, et al. Risk stratification of patients with acute symptomatic pulmonary embolism based on presence or absence of lower extremity DVT: Systematic review and meta-analysis. Chest 2016;149:192-200.
Goldhaber SZ, Visani L, Rosa MD. Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999;353:1386-9.
White H. The epidemiology of venous thromboembolism. Circulation 2003;107:4.
Donzé J, Gal GL, Fine MJ, Roy P-M, Sánchez O, Verschuren F, et al. Prospective validation of the Pulmonary Embolism Severity Index. Thromb Haemost 2008;100:943-8.
Prandoni P, Lensing AWA, Prins MH, Ciammaichella M, Perlati M, Mumoli N, et al. Prevalence of pulmonary embolism among patients hospitalized for syncope. N Engl J Med 2016;375:1524-31.
Martínez JLA, Sánchez FJA, Echezarreta MAU, García IV, Álvaro JR. Central versus peripheral pulmonary embolism: Analysis of the impact on the physiological parameters and long-term survival. North Am J Med Sci 2016;8:134-42.
Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997;112:974-9.
Stein PD, Goldhaber SZ, Henry JW, Miller AC. Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism. Chest 1996;109:78-81.
Rodger MA, Carrier M, Jones GN, Rasuli P, Raymond F, Djunaedi H, et al. Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism. Am J Respir Crit Care Med 2000;162:2105-8.
The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990;263:2753-9.
Perrier A, Roy P-M, Aujesky D, Chagnon I, Howarth N, Gourdier A-L, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-Dimer measurement, venous ultrasound, and helical computed tomography: A multicenter management study. Am J Med 2004;116:291-9.
Ceriani E, Combescure C, Gal GL, Nendaz M, Perneger T, Bounameaux H, et al. Clinical prediction rules for pulmonary embolism: A systematic review and meta-analysis. J Thromb Haemost 2010;8:957-70.
Douma RA, Mos ICM, Erkens PMG, Nizet TAC, Durian MF, Hovens MM, et al. Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism. Ann Intern Med 2011;154:709-18.
Penaloza A, Soulié C, Moumneh T, Delmez Q, Ghuysen A, Kouri DE, et al. Pulmonary embolism rule-out criteria (PERC) rule in European patients with low implicit clinical probability (PERCEPIC): A multicentre, prospective, observational study. Lancet Haematol 2017;4:e615-21.
Perrier A, Roy P-M, Sánchez O, Le Gal G, Meyer G, Gourdier A-L, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med 2005;352:1760-8.
Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: Management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med 2001;135:98-107.
Righini M, Van Es J, Den Exter PL, Roy P-M, Verschuren F, Ghuysen A, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: The ADJUST-PE Study. JAMA 2014;311:1117-24.
Francalanci I, Comeglio P, Liotta AA, Cellai AP, Fedi S, Parretti E, et al. D-dimer concentrations during normal pregnancy, as measured by ELISA. Thromb Res 1995;78:399-405.
Righini M, Gal GL, de Lucía S, Roy P-M, Meyer G, Aujesky D, et al. Clinical usefulness of D-dimer testing in cancer patients with suspected pulmonary embolism. Thromb Haemost 2006;95:715-9.
Elliott CG, Goldhaber SZ, Visani L, DeRosa M. Chest radiographs in acute pulmonary embolism: Results from the international cooperative pulmonary embolism registry. Chest 2000;118:33-8.
Sosland RP, Gupta K. McConnell’s Sign. Circulation 2008;118:e517-8.
Perrier A, Bounameaux H. Ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med 1998;128:243.
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.
Gal GL, Righini M, Sánchez O, Roy P-M, Baba-Ahmed M, Perrier A, et al. A positive compression ultrasonography of the lower limb veins is highly predictive of pulmonary embolism on computed tomography in suspected patients. Thromb Haemost 2006;95:963-6.
Meyer G, Vieillard-Baron A, Planquette B. Recent advances in the management of pulmonary embolism: Focus on the critically ill patients. Ann Intensive Care 2016;6:19.
Martin C, Sobolewski K, Bridgeman P, Boutsikaris D. Systemic thrombolysis for pulmonary embolism: A review. Pharm Ther 2016;41:770-5.
Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, et al. Simplification of the Pulmonary Embolism Severity Index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010;170:1383-9.
Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Beyer-Westendorf J, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014;370:1402-11.
Weinberg I, Jaff MR. Accelerated thrombolysis for pulmonary embolism. Circulation 2014;129:420-1.
Sánchez O, Trinquart L, Colombet I, Durieux P, Huisman MV, Chatellier G, et al. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: A systematic review. Eur Heart J 2008;29:1569-77.
Janssen Pharmaceuticals, Inc. Xarelto (rivaroxaban) prescribing information [Internet]. 2015 [citado 3 de agosto de 2016]. Disponible en: www.xareltohcp.com/shared/product/xarelto/ prescribing- information.pdf.
Collen DC. Molecular mechanisms of fibrinolysis and their application to fibrin-specific thrombolytic therapy. J Cell Biochem 1987;33:77-86.
Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 2005;172:1041-6.
Kearon C, Akl EA, Ornelas J, Blaivas A, Jiménez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease. Chest 2016;149:315-52.
Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002;347:1143- 50.
Brandt K, McGinn K, Quedado J. Low-dose systemic alteplase (tPA) for the treatment of pulmonary embolism. Ann Pharmacother 2015;47:818-24.
Konstantinides S. Thrombolysis in submassive pulmonary embolism? Yes. J Thromb Haemost 2003;1:1127-9.
Vanni S, Nazerian P, Pepe G, Baioni M, Risso M, Grifoni G, et al. Comparison of two prognostic models for acute pulmonary embolism: Clinical vs.