2015, Número 2
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Rev Clin Esc Med 2015; 5 (2)
Tromboembolismo pulmonar: fisiopatología y diagnóstico
Estrada GCF, Garzona NAF
Idioma: Español
Referencias bibliográficas: 122
Paginas: 53-64
Archivo PDF: 296.48 Kb.
RESUMEN
El tromboembolismo pulmonar (TEP) es un
evento clínico frecuente asociado a importante
morbi-mortalidad que varía según características
del evento y del paciente. Múltiples factores de
riesgo han sido identificados con distinto grado
de asociación con TEP, destacando el cáncer, las
enfermedades infecciosas e inflamatorias,
trombosis previas, entre otros. El diagnóstico de
TEP debe basarse en una estrategia clínica lógica,
individualizando al paciente según su grado de
probabilidad, tomando en cuenta los hallazgos
clínicos, de laboratorio y gabinete, analizando
diferentes ventajas y desventajas de cada una de
las herramientas diagnósticas. Este artículo
pretende brindar una revisión de la
epidemiología, fisiopatología y diagnóstico del
TEP.
REFERENCIAS (EN ESTE ARTÍCULO)
Jaff MR McMurtry MS Archer SL et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011; 123:1788-1830.
Kucher N Rossi E De Rosa M Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006;113:577–582.
Kasper W Konstantinides S Geibel A et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol. 1997;30: 1165–1171.
Virchow R. (1855) Archiv fuer pathologische Anatomie und Physiologie und fuer klinische Medizin, 8, 23, [Traducción en: Ackerknecht, E.H. Rudolf Virchow. Doctor, Statesman, Anthropologist. Madison, University of Wisconsin, 1953, pp 83].
Nicolaides AN Kakkar VV Field ES Renney JT. The origin of deep vein thrombosis: a venographic study. Br J Radiol. 1971;44: 653–663.
Tapson V. Acute pulmonary embolism. N Engl J Med. 2008;358:1037-1052.
Killewich LA Bedford GR Beach KW Strandness D. Spontaneous lysis of deep venous thrombi: rate and outcome. J Vasc Surg. 1989;9:89–97.
Heit JA Melton LJ Lohse CM et al. Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clin Proc. 2001;76(11): 1102-1110.
Huerta C Johansson S Wallander MA García LA. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med. 2007;14;167(9):935-943.
Oger E. Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost. 2000;83(5):657-660.
Jang MJ Bang SM Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost. 2011;9(1):85-91.
Molina JA Jiang ZG Heng BH Ong BK. Venous thromboembolism at the National Healthcare Group, Singapore. Ann Acad Med Singapore. 2009;38(6): 470-478.
Stein PD Beemath A Olson RE. Trends in the incidence of pulmonary embolism and deep venous thrombosis in hospitalized patients. Am J Cardiol. 2005;95 (12):1525-1526.
Yang Y Liang L Zhai Z et al. Pulmonary embolism incidence and fatality trends in Chinese hospitals from 1997 to 2008: a multicenter registration study. PLoS One. 2011;6(11):e26861
Kuklina EV Meikle SF Jamieson DJ. Severe obstetric morbidity in the United States: 1998-2005. Obstet Gynecol. 2009;113(2):293-299.
Silverstein MD Heit JA Mohr DN et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158:585-593.
Heit JA Cohen AT Anderson FA. VTE Impact Assessment Group. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the U.S. Blood 2005; 106:267a. abstract.
Hoffmann B Gross CR Jöckel KH Kröger K. Trends in mortality of pulmonary embolism: an international comparison. Thromb Res. 2010;125(4): 303-308.
Kyrle PA Eichinger S. Deep vein thrombosis. Lancet. 2005;365(9465): 1163-1174.
Cushman M Tsai AW White RH et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004;117:19–25.
Kyrle PA Minar E Bialonczyk C Hirschl M Weltermann A Eichinger S. The risk of recurrent venous thromboembolism in men and women. N Engl J Med. 2004;350:2558–2563.
Kniffin WD Baron JA Barrett J Birkmeyer JD Anderson FA. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med. 1994;154:861– 866.
Blom JW Doggen CJ Osanto S Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293:715-722.
Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet. 1999;353: 1167-1173.
Trousseau A. Phlegmasia Alba Dolens: Lectures on Clinical Medicine. London, England: The New Sydenham Society. 1868;5:281-331.
Baron JA Gridley G Weiderpass E Nyren O Linet M. Venous thromboembolism and cancer. Lancet. 1998; 351:1077-1080.
Heit JA Silverstein MD Mohr DN Petterson TM O’Fallon WM Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a populationbased case-control study. Arch Intern Med. 2000;160:809-815.
Horsted F West J Grainge MJ. Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. “Risk of Venous Thromboembolism in Patients with Cancer: PLoS Medicine 9.7 (2012): e1001275.
Prandoni P Lensing AW Cogo A et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125:1–7.
Meignan M Rosso J Gauthier H et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med. 2000;24;160(2):159-164.
Eichinger S Weltermann A Minar E et al. Symptomatic pulmonary embolism and the risk of recurrent venous thromboembolism. Arch Intern Med. 2004; 12;164(1):92-96.
Zöller B Li X Sundquist J Sundquist K. Risk of pulmonary embolism in patients with autoimmune disorders: a nationwide follow-up study from Sweden. Lancet. 2012;21;379(9812):244-249.
Grainge MJ West J Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010; 375(9715):657-663.
Miehsler W Reinisch W Valic E et al. Is inflammatory bowel disease an independent and disease specific risk factor for thromboembolism? Gut. 2004;53(4): 542-548.
Holmqvist ME Neovius M Eriksson J et al. Risk of venous thromboembolism in patients with rheumatoid arthritis and association with disease duration and hospitalization. JAMA. 2012;308(13): 1350-1356.
Kim SC Schneeweiss S Liu J Solomon DH. Risk of venous thromboembolism in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2013;65 (10):1600-1607. http://www.ncbi.nlm.nih.gov.ezproxy.si bdi.ucr.ac.cr:2048/entrez/query.fcgi?cm d=Retrieve&db=pubmed&dopt=Abstra ct&list%5Fuids=23032551&
Bacani AK Gabriel SE Crowson CS Heit JA Matteson EL. Non-cardiac vascular disease in rheumatoid arthritis: increase in venous thromboembolic events? Arthritis Rheum. 2012;64(1): 53-61.
Merkel PA Lo GH Holbrook JT et al. Brief communication: high incidence of venous thrombotic events among patients with Wegener granulomatosis: the Wegener's Clinical Occurrence of Thrombosis (WeCLOT) Study. Ann Intern Med. 2005;19:(8):620-626.
Stassen PM Derks RP Kallenberg CG Stegeman CA. Venous thromboembolism in ANCA-associated vasculitis-- incidence and risk factors. Rheumatology (Oxford). 2008;47(4):530-534.
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(9516): 1075-1079.
Neumann V O'Connor RJ Bhakta BB Tennant A. DVT and pulmonary embolism after acute infection. Lancet. 2006; 368(9531):201.
Bahl V Hu HM Henke PK Wakefield TW Campbell DA Jr Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344-350.
Sweetland S Green J Liu B et al. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study. BMJ. 2009;339:b4583.
Cohen AT. Prevention of postoperative venous thromboembolism. BMJ. 2009; 339:b4477
Sansone JM del Rio AM Anderson PA. The prevalence of and specific risk factors for venous thromboembolic disease following elective spine surgery. Joint Surg Am. 2010;92(2):304-313.
Cheng JS Arnold PM Anderson PA Fischer D Dettori JR. Anticoagulation risk in spine surgery. Spine (Phila Pa 1976). 2010;35(9 Suppl):S117-S124.
Khorana AA Francis CW Blumberg N Culakova E Refaai MA Lyman GH. Blood transfusions, thrombosis, and mortality in hospitalized patients with cancer. Arch Intern Med. 2008;168(21): 2377-2381.
Holst AG Jensen G Prescott E. Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. Circulation. 2010;121(17):1896- 1903.
Hansson PO Eriksson H Welin L Svärd sudd K Wilhelmsen L. Smoking and abdominal obesity: risk factors for venous thromboembolism among middleaged men: “the study of men born in 1913”. Arch Intern Med. 1999;159(16): 1886-1890.
Douketis J Tosetto A Marcucci M et al. Risk of recurrence after venous thromboembolism in men and women: patient level meta-analysis. BMJ. 2011;342: d813.
Eichinger S Hron G Bialonczyk C et al. Overweight, obesity, and the risk of recurrent venous thromboembolism. Arch Intern Med. 2008;168(15):1678-1683.
Piazza G Goldhaber SZ. Pulmonary embolism in heart failure. Circulation. 2008;118(15):1598-1601.
Landolfi R Cipriani MC Novarese L. Thrombosis and bleeding in polycythemia vera and essential thrombocythemia: pathogenetic mechanisms and prevention. Best Pract Res Clin Haematol. 2006;19(3):617-633.
Hoffman PC. Immune hemolytic anemia- selected topics. Hematology Am Soc Hematol Educ Program. 2009:80- 86.
Ray JG Burows RF Ginsberg JS Burrows EA. Paroxysmal nocturnal hemoglobinuria and the risk of venous thrombosis: review and recommendations for management of the pregnant and non-pregnant patient. Haemostasis. 2000;30(3):103-117.
Austin H Key NS Benson JM et al. Sickle cell trait and the risk of venous thromboembolism among blacks. Epub 2007 Apr 4.
Tapson VF. The role of smoking in coagulation and thromboembolism in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005;2(1):71-77.
Torbicki A Perrier A Konstantinides S et al. 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). Eur Heart J. 2008;29(18):2276-2315.
Lucassen W Geersing GJ Erkens PM et al. Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med. 2011;155(7):448-460.
Stein PD Beemath A Matta F et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med. 2007;120(10): 871-879.
Qaseem A Snow V Barry P et al. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Fam Med. 2007;5(1):57-62.
Segal JB Eng J Tamariz LJ Bass EB. Review of the evidence on diagnosis of deep venous thrombosis and pulmonary embolism. Ann Fam Med. 2007;5(1):63- 73.
Qaseem A Snow V Barry P et al. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med. 2007;146(6):454-458.
Campos-Outcalt D. New guidelines on DVT and pulmonary embolism. Am Fam Physician. 2007;76(8):1116.
Chapman NH Brighton T Harris MF Caplan GA Braithwaite J Chong BH. Venous thromboembolism - management in general practice. Aust Fam Physician. 2009;38(1-2):36-40.
Lucassen W Geersing GJ Erkens PM et al. Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med. 2011;155(7):448-460.
Geersing GJ Erkens PM Lucassen WA et al. Safe exclusion of pulmonary embolism using the Wells rule and qualitative D-dimer testing in primary care: prospective cohort study. BMJ. 2012;345:e6564.
Kruip MJ Leclercq MG van der Heul C Prins MH Büller HR. Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies. A systematic review. Ann Intern Med. 2003;138(12): 941-951.
Jacobs LG. When are you sure that you are wrong? How to exclude a pulmonary embolism. J Am Geriatr Soc. 2004; 52(2):311-313.
Rodger MA Carrier M Jones GN et al. Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism. Am J Respir Crit Care Med. 2000;162(6):2105-2108.
Stein PD Terrin ML Hales CA et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100(3):598- 603.
Tapson VF. Pulmonary embolism: the diagnostic repertoire. Chest. 1997;112 (3):578-580.
Stein PD Goldhaber SZ Henry JW. Alveolar- arterial oxygen gradient in the assessment of acute pulmonary embolism. Chest. 1995;107(1):139-143.
Stein PD Goldhaber SZ Henry JW Miller AC. Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism. Chest. 1996;109(1): 78-81.
Egermayer P. Normoxemia and pulmonary embolism. Chest. 2001;120(5): 1756.
Deutsch AB Twitty P Downes K Parsons MT. Assessment of the alveolararterial oxygen gradient as a screening test for pulmonary embolism in pregnancy. Am J Obstet Gynecol. 2010;203 (4):373.e1-4.
Tapson VF Carroll BA Davidson BL et al. The diagnostic approach to acute venous thromboembolism. Clinical practice guideline. American Thoracic Society. Am J Respir Crit Care Med. 1999;160(3):1043-1066
Rodger MA Carrier M Jones GN et al. Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism. Am J Respir Crit Care Med. 2000;162(6):2105-2108.
Wicki J Perneger TV Junod AF Bounameaux H Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med. 2001;161(1): 92-97.
Jay SJ. Is smoking a risk factor for pulmonary embolism? Arch Intern Med. 2001;161(15):1925-1926.
Le Gal G Righini M Roy PM et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006; 144(3):165-171.
Sox HC. Better care for patients with suspected pulmonary embolism. Ann Intern Med. 2006;144(3):210-212.
Dunn A. The revised Geneva score predicted pulmonary embolism in patients with shortness of breath or chest pain. ACP J Club. 2006;145(1):25.
Douma RA Mos IC Erkens PM et al. Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism: a prospective cohort study. Ann Intern Med. 2011;154 (11):709-718.
Yap KS Kalff V Turlakow A Kelly MJ. A prospective reassessment of the utility of the Wells score in identifying pulmonary embolism. Med J Aust. 2007;187 (6):333-336.
Biss TT Brandão LR Kahr WH Chan AK Williams S. Clinical probability score and D-dimer estimation lack utility in the diagnosis of childhood pulmonary embolism. J Thromb Haemost. 2009;7(10):1633-1638.
Miniati M Bottai M Monti S Salvadori M Serasini L Passera M. Simple and accurate prediction of the clinical probability of pulmonary embolism. Am J Respir Crit Care Med. 2008;178(3):290- 294.
Miniati M Bottai M Monti S. Comparison of 3 clinical models for predicting the probability of pulmonary embolism. Medicine (Baltimore). 2005;84(2):107- 114.
Singh B Parsaik AK Agarwal D Surana A Mascarenhas SS Chandra S. Diagnostic accuracy of pulmonary embolism rule-out criteria: a systematic review and meta-analysis. Ann Emerg Med. 2012;59(6):517-520.
Roy PM Colombet I Durieux P Chatellier G Sors H Meyer G. Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ. 2005;331 (7511):259.
Stein PD Athanasoulis C Alavi A et al. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation. 1992;85(2):462- 468.
Singh H Cardella JF Cole PE et al. Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 2002;13(1):1-6.
Moores LK Jackson WL Jr Shorr AF Jackson JL. Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography. Ann Intern Med. 2004;141(11):866-874.
Frost SD. Defining the role of computed tomographic pulmonary angiography in suspected pulmonary embolism. Ann Intern Med. 2005;142(9):800-801.
Mos IC Klok FA Kroft LJ DE Roos A Dekkers OM Huisman MV. Safety of ruling out acute pulmonary embolism by normal computed tomography pulmonary angiography in patients with an indication for computed tomography: systematic review and meta-analysis. J Thromb Haemost. 2009;7(9):1491- 1498.
Quiroz R Kucher N Zou KH et al. Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review. JAMA. 2005;293(16):2012- 2017.
Stein PD Kayali F Hull RD. Spiral computed tomography for the diagnosis of acute pulmonary embolism. Thromb Haemost. 2007;98(4):713-720.
Mullins MD Becker DM Hagspiel KD Philbrick JT. The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism. Arch Intern Med. 2000;160(3):293-298.
Kane KY Ellis MR. Is spiral (helical) computed tomography useful for diagnosing pulmonary embolism? J Fam Pract. 2000;49(5):467-468.
Kelly MJ Pitman A. Defining the role of helical computerised tomography (CT) in the diagnosis of pulmonary embolism (PE). Aust N Z J Med. 2000;30(2):191- 193.
Stein PD Fowler SE Goodman LR et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354(22):2317-2327.
Brotman DJ. Computed tomography for pulmonary embolism. N Engl J Med. 2006;355(9):955.
Cronin P Weg JG Kazerooni EA. The role of multidetector computed tomography angiography for the diagnosis of pulmonary embolism. Semin Nucl Med. 2008;38(6):418-431.
Perrier A. Multidetector CTA with venography was more sensitive for diagnosing pulmonary embolism than CTA alone. ACP J Club. 2006;145(3):76.
Perrier A Bounameaux H. Accuracy or outcome in suspected pulmonary embolism. N Engl J Med. 2006;354(22): 2383-2385.
Kaatz S Buckley J. Review: helical CT has better discriminatory power than ventilation-perfusion scan to exclude pulmonary embolism. ACP J Club. 2005;143(2):52.
Hayashino Y Goto M Noguchi Y Fukui T. Ventilation-perfusion scanning and helical CT in suspected pulmonary embolism: meta-analysis of diagnostic performance. Radiology. 2005;234(3):740- 748.
Turkstra F Kuijer PM van Beek EJ Brandjes DP ten Cate JW Büller HR. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med. 1997;126(10):775-781.
Sheiman RG McArdle CR. Clinically suspected pulmonary embolism: use of bilateral lower extremity US as the initial examination--a prospective study. Radiology. 1999;212(1):75-78.
Perrier A Roy PM Sánchez O et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005;352(17):1760- 1768.
Goldhaber SZ. Multislice computed tomography for pulmonary embolism: a technological marvel. N Engl J Med. 2005;352(17):1812-1814.
Turpie AG. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005;353(6): 630-631.
Le Gal G Righini M Mottier D. Clinical diagnosis of pulmonary embolism: a real challenge. Rev Med Interne. 2007;28 (6):394-399.
Stein PD Gottschalk A Sostman HD. Methods of Prospective Investigation of Pulmonary Embolism Diagnosis III (PIOPED III). Semin Nucl Med. 2008;38(6):462-470.
Stein PD Chenevert TL Fowler SE et al. Gadolinium-enhanced magnetic reso nance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med. 2010; 152(7):434-443.
Davidson BL Lacrampe MJ. Why can't magnetic resonance imaging reliably diagnose pulmonary embolism? Ann Intern Med. 2010;152(7):467-468.
Brown G Hogg K. Best evidence topic report. Diagnostic utility of electrocardiogram for diagnosing pulmonary embolism. Emerg Med J. 2005;22(10):729- 730.
Harrigan RA Jones K. ABC of clinical electrocardiography. Conditions affecting the right side of the heart. BMJ. 2002;324(7347):1201-1204.
Ryan D Hong T Bardeesy N. Pancreatic Adenocarcinoma. N Engl J Med 2014;371:1039-1049.
Simard E Ward E Siegel R Jemal A. Cancers With Increasing Incidence Trends in the United States: 1999 Through 2008. CA Cancer J Clin. 2012; 62:118-128.
Krejs G. Pancreatic Cancer: Epidemiology and Risk Factors. Dig Dis 2010; 28:355–358.
Habib M Wasif Saif M. Thromboembolism and Anticoagulation in Pancreatic Cancer. JOP. J Pancreas (Online) 2013; 14(2):135-137.