Article information
Resumo
A doença pulmonar tromboembólica, parte integrante do tromboembolismo venoso, constitui um importante problema de saúde, dado que acarreta um risco significativo de mortalidade e morbilidade, com elevado custo social e económico. O diagnóstico e terapêutica atempados, bem como uma profilaxia apropriada, são factores determinantes no prognóstico. Esta entidade clínica continua a suscitar particular atenção, nomea-damente no que respeita à investigação dos factores de risco, desenvolvimento de algoritmos de probabilidade clínica, avaliação dos exames complementares de diagnóstico, definição de novas abordagens terapêuticas e recomendações para tromboprofilaxia. No presente trabalho procura-se rever o conhecimento científico actual relativo ao tromboembolismo pulmonar, focan-do as vertentes anteriormente mencionadas.
Rev Port Pneumol 2009; XV (3): 483-505
Palavras-chave:
Tromboembolismo pulmonar
tromboembolismo venoso
diagnóstico
tratamento
profilaxia
anticoagulação
Abstract
Pulmonary embolism is part of venous thromboem-bolism, an important health problem which leads to significant mortality and morbidity with high economic and social burden. A prompt diagnosis and treatment as well as an appropriate prophylaxis are deter-minant factors in prognosis. This disease continues to demand particular attention namely in the investigation of risk factors, clinical probability algorithms development, diagnostic work-up evaluation, characterization of new therapeutic strategies and thromboprophylaxis recommendations. The present review looks into the current scientific knowledge regarding pulmonary embolism.
Rev Port Pneumol 2009; XV (3): 483-505
Key-words:
Pulmonary embolism
venous thromboembolism
diagnosis
treatment
prophylaxis
anticoagulation
Full text is only aviable in PDF
Bibliografia
[1.]
Prevention and treatment of venous thromboembolism: International Consensus Statement (guidelines according to scientific evidence).
Int Angiol, 25 (2006), pp. 101-161
[2.]
R.H. White.
The epidemiology of venous thromboem-bolism.
Circulation, 107 (2003), pp. 14-18
[3.]
A.K. Jaffer.
An overview of venous thromboembolism: impact, risks, and issues in prophylaxis.
Cleveland Clinic Journal of Medicine, 75 (2008), pp. S3-S6
[4.]
M.D. Silverstein, J.A. Heit, D.N. Mohr, C.M. Lohse, T.M. Petterson, W.M. O'Fallon, L.J. Melton 3rd..
Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.
Arch Intern Med, 158 (1998), pp. 585-593
[5.]
W.H. Geerts, D. Bergqvist, G.F. Pineo, J.A. Heit, C.M. Samama, M.R. Lassen, C.W. Colwell.
Prevention of venous thromboembolism. American College of Chest Physicians Evidence-based Clinical Practical Guidelines (8th Edition).
Chest, 133 (2008), pp. 381S-453S
[6.]
L. Dexter, W. Folch Pi.
Venous thrombosis: an account of the first documented case.
J Am Med Ass, 228 (1974), pp. 195-196
[7.]
P.M. Mannucci.
Venous thrombosis: the history of knowledge.
Pathophysiol Haemost Thromb, 32 (2002), pp. 209-212
[8.]
J. Ferrier.
An affectation of the lymphatic vessels hitherto misunderstood.
Medical Histories and, Reflections, III (1810),
[9.]
M.E. De Bakey.
Collective review: a critical evaluation of the problems of thromboembolism.
International Abstracts of Sugery, 98 (1954), pp. 1-27
[10.]
G. Bauer.
A roentgenological and clinical study of the sequels of thrombosis.
Acta Chirur Scandin, 86 (1942), pp. 106-112
[11.]
B.C. Dickson.
Venous thrombosis: on the history of Virchow’s triad.
UTMJ, 81 (2004), pp. 166-171
[12.]
F.A. Anderson Jr., F.A. Spencer.
Risk factors for venous thromboembolism.
Circulation, 107 (2003), pp. 19-116
[13.]
F.A. Anderson Jr., H.B. Wheeler.
Physician practices in the management of venous thromboembolism: a community-wide survey.
J Vasc Surg, 16 (1992), pp. 707-714
[14.]
R. Collins, A. Scrimgeour, S. Yussuf, R. Peto.
Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin: overview of results of randomized trials in general, orthopedic, and urologic surgery.
N Engl J Med, 318 (1998), pp. 1162-1173
[15.]
W.H. Geerts, K.I. Code, R.M. Jay, E. Chen, J.P. Szalai.
A prospective study of venous thromboembolism after major trauma.
N Engl J Med, 331 (1994), pp. 1601-1606
[16.]
L.S. Elting, C.P. Escalante, C. Cooksley, E.B. Avritscher, D. Kurtin, L. Hamblin, S.G. Khosla, E. Rivera.
Outcomes and cost of deep venous thrombosis among patients with cancer.
Arch Intern Med, 164 (2004), pp. 1653-1661
[17.]
P.D. Stein, A. Beemath, F.A. Meyers, F. Kayali, E. Skaf, R.E. Olson.
Pulmonary embolism: a cause of death in patients who died with cancer.
Am J Med, 119 (2006), pp. 163-165
[18.]
P. Pandroni, A. Falanga, A. Piccioli.
Cancer and venous thromboembolism.
Lancet Oncol, 6 (2005), pp. 401-410
[19.]
R. Jacques, S.F. Paul Man, Don D. Sin.
Prevalence of pulmonary embolism in acute exacerbations of chronic obstructive pulmonary disease: a systematic review and meta-analysis.
Chest, (2008), pp. 23
[20.]
W. Ageno, C. Becattini, T. Brighton, R. Selby, P.W. Kam-phuisen.
Cardiovascular risk factors and venous thromboembolism: a meta-analysis.
Ciculation, 117 (2008), pp. 93-102
[21.]
S.Z. Goldhaber, F. Grodstein, M.J. Stampfer, J.E. Manson, G.A. Colditz, F.E. Speizer, W.C. Willett, C.H. Hennekens.
A prospective study of risk factors for pulmonar embolism in women.
JAMA, 277 (1997), pp. 642-645
[22.]
R.D. Farmer, R.A. Lawrenson, J.C. Todd, T.J. Williams, K.D. MacRae, F. Tyrer, G.M. Leydon.
A comparison of the risks of venous thromboembolic disease in association with different combien oral contraceptives.
Br J Clin Pharmacol, 49 (2000), pp. 580-590
[23.]
E.R. Pomp, F.R. Rosendaal, C.J. Doggen.
Smoking increases the risk thrombosis and acts synergically with oral contraceptive use.
Am J Hematol, 83 (2008), pp. 97-102
[24.]
D.R. Danilenko-Dixon, J.A. Heit, M.D. Silverstein, B.P. Yawn, T.M. Petterson, C.M. Lohse, L.J. Melton 3rd..
Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post-partum: a popula- tion based, case control study.
Am J Obstet Gynecol, 184 (2001), pp. 104-110
[25.]
J.L. Kukovich.
Hormones and pregnancy: thrombolic risks for women.
Br J Haematol, 126 (2004), pp. 443-454
[26.]
G. Lowe, M. Woodward, M. Vessey, A. Rumley, P. Gough, E. Daly.
Thrombotic variables and risk of idio-patic venous thromboembolism in women aged 45-64 years. Relationships to hormone replacement therapy.
Thromb Haemost, 83 (2000), pp. 530-535
[27.]
Lip Gy, C.R. Gibbs.
Does heart failure confer a hy-percoagulable state? Virchow’s triad revisited.
J Am Coll Cardiol, 33 (1999), pp. 1424-1426
[28.]
C. Warlow, D. Ogston, A.S. Douglas.
Venous thrombosis following strokes.
Lancet, 1 (1972), pp. 1305-1306
[29.]
National Space and Aeronautics Administration.
Flight-related deep vein thrombosis–economy class syndrome.
[30.]
J. Mateo, A. Oliver, M. Borrell, N. Sala, J. Fontcuberta.
Laboratory evaluation and clinical characteristics of 2132 consecutive unselected patients with venous thromboembolism – results of the Spanish Multicentric Study on Thrombophilia (EMET-Study).
Thromb Hea-most, 77 (1997), pp. 444-451
[31.]
M.A. Crowther, J.G. Kelton.
Congenital thrombofilic states associated with venous thrombosis: a qualitative overview and proposed classification system.
Ann Intern Med, 138 (2003), pp. 128-134
[32.]
S. Eichinger, A. Weltermann, E. Minar, M. Stain, V. Schönauer, B. Schneider, P.A. Kyrle.
Symptomatic pulmonary embolism and the risk of recurrent venous thromboembolism.
Arch Intern Med, 164 (2004), pp. 92-96
[33.]
E.E. Weinman, E.W. Salzman.
Deep vein thrombosis.
N Engl J Med, 331 (1994), pp. 1630-1641
[34.]
S. Goldhaber.
Pulmonary embolism.
Lancet, 363 (2004), pp. 1295-1305
[35.]
L. Belenkie, R. Dani, E.R. Smith, J.V. Tyberg.
Ventricular interaction during experimental acute pulmonary embolism.
Circulation, 78 (1998), pp. 761-768
[36.]
T. Minichielli, P.F. Fogarty.
Diagnosis and management of venous thormboembolism.
Med Clin N Am, (2008), pp. 443-465
[37.]
Guidelines on diagnosis and management of acute pulmonary embolism.
Task Force on Pulmonary Embo-lism, European Society of Cardiology.
Eur Heart J, 201 (2000), pp. 1301-1336
[38.]
N. Kucher, S.Z. Goldhaber.
Management of massive pulmonary embolism.
Circulation, 112 (2005), pp. e28-e32
[39.]
P.D. Stein, A. Beemath, F. Matta, J.G. Weg, R.D. Yusen, C.A. Hales, R.D. Hull, K.V. Leeper Jr., H.D. Sostman, V.F. Tap-son, J.D. Buckley, A. Gottschalk, L.R. Goodman, T.W. Wakefied, P.K. Woodard.
Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II.
Am J Med, 120 (2007), pp. 871-879
[40.]
P.S. Wells.
Integrated strategies for the diagnosis of venous thromboembolism.
J Thromb Haemost, 5 (2007), pp. 41-50
[41.]
J. West, S. Goodacre, F. Sampson.
The value of clinical features in the diagnosis of acute pulmonary embolism: systematic review and meta-analysis.
QJM, 100 (2007), pp. 763-769
[42.]
P.D. Stein, R.D. Hull, K.C. Patel, R.E. Olson, W.A. Ghali, R. Brant, R.K. Biel, V. Bharadia, N.K. Kalra.
D-dimer for the exclusion of acute venous thrombosis and pul-monary embolism: a systematic review.
Ann Intern Med, 140 (2004), pp. 589-602
[43.]
J.A. Kline, M.S. Runyon, W.B. Webb, A.E. Jones, A.M. Mit-chell.
Prospective study of the diagnostic accuracy of the simplified d-dimer assay for pulmonary embolism in emergency department patients.
Chest, 129 (2006), pp. 1417-1423
[44.]
C. Kearon, J.S. Ginsberg, J. Douketis, A.G. Turpie, S.M. Bates, A.Y. Lee, M.A. Crowther, J.I. Weitz, P. Brill–Edwards, P. Wells, D.R. Anderson, M.J. Kovacs, L.A. Linkins, J.A. Julian, L.R. Bonilla, M. Gent.
Canadian Pulmonary Embolism Diagnosis Study (CANPEDS) Group. An evaluation of d-dimer in the diagnosis of pulmonary embolism: a randomized trial.
Ann Intern Med, 144 (2006), pp. 812-821
[45.]
D.G. Kiely, N.S. Kennedy, O. Pirzada, S.A. Batchelor, A.D. Struthers, B.J. Lipworth.
Elevated levels of natriuretic peptides in patients with pulmonary thromboem-bolism.
Resp Med, 99 (2005), pp. 1286-1291
[46.]
F.A. Klok, I.C. Mos, M.V. Huisman.
Brain-type natriu-retic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism: a systematic review and meta-analysis.
Am J Respir Crit Care Med, 178 (2008), pp. 425-430
[47.]
E. Giannitsis, M. Müller-Bardorff, V. Kurowski, B. Wei-dtmann, U. Wiegand, M. Kampmann, H.A. Katus.
Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism.
Circulation, 102 (2000), pp. 211-217
[48.]
P. Pruszczyk, A. Bochowicz, A. Torbicki, M. Szulc, M. Kurzyna, A. Fijałkowska, A. Kuch-Wocial.
Cardiac troponin T monitoring identifies high risk group of normotensive patients with acute pulmonary embolism.
Chest, 123 (2003), pp. 1947-1952
[49.]
M.A. Rodger, M. Carrier, G.N. Jones, P. Rasuli, F. Raymond, H. Djunaedi, P.S. Wells.
Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism.
Am J Resp Crit Care Med, 162 (2000), pp. 2105-2108
[50.]
Task Force on Pulmonary Embolism. European Society of Cardiology.
Guidelines on diagnosis and management of acute pulmonary embolism.
Eur Heart J, 21 (2000), pp. 1301-1336
[51.]
N.S. Gibson, M. Sohne, H.R. Buller.
Prognostic value of echocardiography and spiral computed tomography in patients with pulmonary embolism.
Curr Opin Pulm med, 11 (2005), pp. 380-384
[52.]
S.Z. Goldhaber.
Echocardiography in the management of pulmonary embolism.
Ann Intern Med, 136 (2002), pp. 691-700
[53.]
B. Zierler.
Ultrassonography and diagnosis of venous thromboembolism.
Circulation, 109 (2004), pp. I9-14
[54.]
The PIOPED Investigators.
Investigators. Value of the ventilation/perfusion scanning scan in acute pulmonary embolism: results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED).
JAMA, 263 (1990), pp. 2753-2759
[55.]
Y. Hayashino, M. Goto, Y. Noguchi, T. Fukui.
Ventilation-perfusion scanning and helical CT in suspected pulmonary embolism: meta-analysis of diagnostic performance.
Radiology, 234 (2005), pp. 740-748
[56.]
U.J. Schoepf, S.Z. Goldhaber, P. Costello.
Spiral computed tomography for acute pulmonary embolism.
Circulation, 109 (2004), pp. 2160-2167
[57.]
A. Perrier, M.R. Nendaz, F.P. Sarasin, N. Howarth, H. Bournameaux.
Cost-effectiveness analysis of diagnostic strategies for suspected thromboembolism including helical computed tomography.
Am Resp Crit Care Med, 167 (2003), pp. 39-44
[58.]
M. Pistolesi, M. Miniati.
Imaging techniques in treatment algorithms of pulmonary embolism.
Eur Resp J, 19 (2002), pp. 28S-39S
[59.]
L.V. Hofmann, D.S. Lee, A. Gupta, A. Arepally, S. Sood, R. Girgis, J. Eng.
Safety and hemodynamic effects of pulmonary angiography in patients with pulmonary hypertension: 10 year single center experience.
AJR Am J Roentgenol, 183 (2004), pp. 779-786
[60.]
E.R. Hudson, T.P. Smith, V.G. McDermott, G.E. Newman, P.V. Suhocki, C.S. Payne, D.J. Stackhouse.
Pulmonary angiography performed with iopamidol: complications in 1434 patients.
Radiology, 198 (1996), pp. 61-65
[61.]
K.T. Horlander, D.M. Mannino, K.V. Leeper.
Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data.
Arch Intern Med, 163 (2003), pp. 1711-1717
[62.]
C. Kearon.
Natural history of venous thromboembolism.
Circulation, 107 (2003), pp. I22-30
[63.]
P. Dartevelle, E. Fadel, S. Mussot, A. Chapelier, P. Hervé, M. de Perrot, J. Cerrina, F.L. Ladurie, D. Lehouerou, M. Humbert, O. Sitbon, G. Simonneau.
Chronic thromboembolic pulmonary hypertension.
Eur Respir J, 23 (2004), pp. 637-648
[64.]
M. ten Wolde, M. Söhne, E. Quak, M.R. Mac Gillavry, H.R. Büller.
Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism.
Arch Intern Med, 164 (2004), pp. 1685-1689
[65.]
F. Pieralli, I. Olivotto, S. Vanni, A. Conti, A. Camaiti, G. Targioni, S. Grifoni, G. Berni.
Usefulness of bedside testing brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism.
Am J Cardiol, 97 (2006), pp. 1386-1390
[66.]
A. Torbicki, N. Galié, A. Covezzoli, E. Rossi, M. De Rosa, S.Z. Goldhaber.
ICOPER Study Group. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry.
J Am Coll Cardiol, 41 (2003), pp. 2245-2251
[67.]
C. Becattini, M.C. Vedovati, G. Agnelli.
Prognostic value of troponins in acute pulmonary embolism: a meta-analysis.
Circulation, 116 (2007), pp. 427-433
[68.]
C. Kearon, S. Kahn, G. Agnelli, S. Goldhaber, E. Raskob, A.J. Comerota.
Antithrombotic therapy for venous thromboembolic disease. American College of Chest Physicians Evidence-based Clinical Practical Guidelines (8th Edition).
Chest, 133 (2008), pp. 454S-545S
[69.]
D.J. Quinlan, A. McQuillan, J.W. Eikelboom.
Low-molecular-weight heparin compared with intravenous unfractionated heparin for treatment of pulmonary embolism: a meta-analysis of randomized, controlled trials.
Ann Intern Med, 140 (2004), pp. 175-183
[70.]
T.A. Morris, S. Castrejon, G. Devendra, A.C. Gamst.
No difference in risk for thrombocytopenia during treatment of pulmonary embolism and deep venous thrombosis with either low-molecular-weight heparin or unfractionated heparin: a metaanalysis.
Chest, 132 (2007), pp. 1108-1110
[71.]
A.G. Turpie, A.S. Gallus, J.A. Hoek.
A synthetic pentas-sacaride for the prevention of deep vein thrombosis.
N Eng J Med, 344 (2001), pp. 619-625
[72.]
http://www.fda.gov/medwatch/SAFETY/2004/may_PI/Arixtra_PI.pdf (Acedido Outubro 2008).
[73.]
D.K. Wysowsky, P. Nourjah, L. Swartz.
Bleeding complications with warfarin use: a prevalent adverse event resulting in regulatory action.
Arch Intern Med, 167 (2007), pp. 1414-1419
[74.]
J. Ansell, J. Hirsh, E. Hylek, A. Jacobson, M. Crowther, G. Palareti.
Pharmacology and management of the vita- min K antagonists. American College of Chest Physicians Evidence-based Clinical Practical Guidelines (8th Edition).
Chest, 133 (2008), pp. 160S-198S
[75.]
S.Z. Goldhaber.
Thrombolytic therapy for patients with pulmonary embolism who are hemodynamically stable but have right ventricular dysfunction.
Arch Inter Med, 165 (2005), pp. 2197-2199
[76.]
G. Thabut, D. Thabut, R.P. Myers, B. Bernard-Chabert, R. Marrash-Chahla, H. Mal, M. Fournier.
Thrombolityc therapy of pulmonary embolism: a meta-analysis.
J Am Coll Cardiol, 40 (2002), pp. 1600-1607
[77.]
B. Dong, Y. Jirong, G. Liu, Q. Wang, T. Wu.
Throm-bolytic therapy for pulmonary embolism.
Cochrane Database Syst Rev, (2006),
[78.]
T.P. Baglin, J. Brush, M. Streiff.
Guidelines on use of vena cava filters.
Br J Haematol, 134 (2006), pp. 590-595
[79.]
Eight year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study.
Circulation, 112 (2005), pp. 416-422
[80.]
M. Nijkeuter, M.M. Hovens, B.L. Davidson, M.V. Huisman.
Resolution of thromboemboli in patients with acute pulmonary embolism: a systematic review.
Chest, 129 (2006), pp. 192-197
[81.]
H.V. Naina, F.J. Quevedo.
Acute pulmonar embolism.
N Engl J Med, 358 (2008), pp. 1037-1052
[82.]
A.L. Brueil, E.M. Umland.
Outpatient management of anticoagulation therapy.
Am Fam Physician, 75 (2007), pp. 1031-1042
[83.]
A.S. Dunn, A.G. Turpie.
Perioperative management of patients receiving antoicoagulants: a systematic review.
Arch Intern Med, 163 (2003), pp. 901-908
[84.]
S.M. Jafri.
Periprocedual thromboprophylaxis in patients receiving chronic anticoagulation therapy.
Am Heart J, 147 (2004), pp. 3-15
[85.]
J.D. Douketis, J.A. Johnson, A.G. Turpie.
Low molecular weight heparin as bridging anticoagulation during interruption of warfarin: assessment of a standardized periprocedual anticoagulation regimen.
Arch Intern Med, 164 (2004), pp. 1319-1326
[86.]
A.T. Cohen, V.F. Tapson, J.F. Bergmann, S.Z. Goldhaber, A.K. Kakkar, B. Deslandes, W. Huang, M. Zayaruzny, L. Emery, F.A. Anderson Jr..
Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE Study): a multinational cross-sectional study.
Lancet, 371 (2008), pp. 387-394
[87.]
M.M. Samama, A.T. Cohen, J.Y. Darmon, L. Desjardins, A. Eldor, C. Janbon, A. Leizorovicz, H. Nguyen, C.G. Olsson, A.G. Turpie, N. Weisslinger.
A comparison of enoxa-parin with placebo for the prevention of venous thromboembolism in acutely ill medical patients.
N Eng J Med, 341 (1999), pp. 793-800
[88.]
A. Leizorovicz, A.T. Cohen, A.G. Turpie, C.G. Olsson, P.T. Vaitkus, S.Z. Goldhaber.
PREVENT Medical Thromboprophylaxis Study Group. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients.
Circulation, 110 (2004), pp. 874-879
[89.]
A.T. Cohen, B.L. Davidson, A.S. Gallus, M.R. Lassen, M.H. Prins, W. Tomkowski, A.G. Turpie, J.F. Egberts, A.W. Lensing.
ARTEMIS Investigators.
Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomized placebo controlled trial. BMJ, 332 (2006), pp. 325-329
[90.]
R.D. Hull, S.M. Schellong, V.F. Tapson, M. Monreal, M.M. Samama, A.G. Turpie, P. Wildgoose, R.D. Yusen.
Extended-duration venous thromboembolism prophylaxis in acutely ill medical patients with recent reduced mobility: the EXCLAIM study.
J Thromb Haemost, 5 (2007), pp. OS001
Copyright © 2009. Sociedade Portuguesa de Pneumologia/SPP
Recommended
articles
articles
Pulmonol. 2024;30:159-69
10.1016/j.pulmoe.2023.10.002
Pulmonol. 2024;30:475-84
Open access
This work is licensed under a Creative Commons Attribution 4.0 International License.
Publish in
Pulmonology
Pulmonology
- Home
- All contents
- Publish your article
- About the journal
- Metrics
- Open access
Article options