Hopp til hovedinnhold

Lungeemboli

Sist oppdatert: Sist revidert:
Sist revidert av:
Definisjon:
Lungeemboli (LE), er en okklusjon (blodpropp) av en eller flere pulmonalarterier, oftest embolus fra dyp venetrombose
Forekomst:
Prevalens øker fra 0,1-1,7% fra 50 til 75 års alder
Symptomer:
Symptombildet varierer betydelig fra kun hoste til betydelige akutte brystsmerter og pustevansker og plutselig død
Funn:
Kliniske funn er takypné av ulik grad, hurtig puls, ev. lavt blodtrykk (sjokksymptomer, gråblek og fuktig hud), og nedsatt fingeroksymetri. Kan ha feber og være medtatt og urolig
Diagnostikk:
Wells (eller Geneva) skår, D-dimer og diagnosen bekreftes ved CT-thorax, alternativt VP SPECT
Behandling:
Akuttbehandling med LMW-heparin, ev. under diagnostisk utredning, oftest rask overgang til DOAK eller warfarin ved sikker diagnose
  1. Konstantinides SV, Meyer G, Becattini C, 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 2019. doi:10.1093/eurheartj/ehz405 DOI  
  2. Baksaas ST, Geiran OR, Iversen S. Kirurgi ved kronisk lungeemboli. Tidsskr Nor Lægeforen 2001; 121: 431-3. tidsskriftet.no  
  3. Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis 2016; 41: 3-14. pmid:26780736 PubMed  
  4. Douketis J, Tosetto A, Marucci M, et al. Risk of recurrence after venous thromboembolism in men and women: patient level meta-analysis. BMJ 2011; 342: d813. PubMed  
  5. Apenteng PN, Hobbs FR, Roalfe A, et al. Incidence of venous thromboembolism in care homes: a prospective cohort study. Br J Gen Pract 2017 Feb; 67 (655): e130-e137. pmid:28093420 PubMed  
  6. Di Minno MN, Ambrosino P, Ambrosino F, et al. Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis. J Thromb Haemost. 2016; 14: 964-72. pmid:26845754 PubMed  
  7. Huang W, Goldberg RJ, Anderson FA, et al . Occurrence and predictors of recurrence after a first episode of acute venous thromboembolism: population-based Worcester Venous Thromboembolism Study. J Thromb Thrombolysis 2016. pmid:26847621 PubMed  
  8. Andreassen AK. Kronisk tromboembolisk pulmonal hypertensjon. Hjerteforum 2016; 29 (nr. 3): 19-25. www.legeforeningen.no  
  9. Hughes MJ, Stein PD, Matta F. Silent pulmonary embolism in patients with distal deep venous thrombosis: systematic review. Thromb Res. 2014 Dec;134(6):1182-5. doi: 10.1016/j.thromres.2014.09.036 DOI  
  10. Velmahos GC, Spaniola K, Tabbara M, et al. Pulmonary embolism and deep venous thrombosis in trauma: are they related?. Arch Surg 2009; 144: 928-32. PubMed  
  11. Stanley A and Young A. Primary prevention of thromboembolism in medical and surgical oncology patients. BJC 2010; 102; S10-16.
  12. Goldhaber SZ.Risk factors for venous thromboembolism. J Am Coll Cardiol 2010; 56: 1-7. PubMed  
  13. Eichinger S, Weltermann A, Minar E, et al. Symptomatic pulmonary embolism and the risk of recurrent venous thromboembolism. Arch Intern Med 2004; 164: 92-6. PubMed  
  14. Carrier M, Le Gal G, Wells PS, Fergusson D, Ramsay T, Rodger MA. Systematic review: The Trousseau Syndrome revisited: Should we screen extensively for cancer in patients with venous thromboembolism? Ann Intern Med 2008;149: 323-33. Annals of Internal Medicine  
  15. Trigg DE, Wood MG, Koides PA et al. Hormonal Influences on Haemostasis in Women. Sem Thromb Haemost 2011; 37: 77-86. PubMed  
  16. Reid R, Leyland N, Wolfman W et al.Oral Contraceptives and the Risk of venous thromboembolism: An Update. J Obstet Gynaecol Can 2010; 32: 1192-7. PubMed  
  17. Olie V, canonico M, Scarabin P-Y. Postmenopausal hormone therapy and venous thromboembolism. Thrombosis Res 2011 (E-Pub ahead of print).
  18. Canonico M, Plu-Bureau G, Lowe GDO, Scarabin P-Y. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis . BMJ 2008; 336: 1227-31. British Medical Journal  
  19. Deneux-Tharaux C, saucedo M, Bouvier-Colle MH. Pulmonary embolism in pregnancy. The Lancet 2010; 375: 1778-9. The Lancet  
  20. Hervig T, Haram K, Sandset PM. Dyp venetrombose hos gravide. Tidsskr Nor Lægeforen 1998; 118: 4093-7. PubMed  
  21. Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med 2002; 346: 752-63. New England Journal of Medicine  
  22. Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med 2010 Nov 6. Epub ahead of print.
  23. Watson HG and Baglin TP. Guidelines on travel-related venous thrombosis. BJH 2011; 152: 31-34. PubMed  
  24. Wells PS. Integrated strategies for the diagnosis of venous thromboembolism. J Thromb Haemost 2007; 5 (suppl. 1): 41-50.
  25. Hendriksen JMT, Geersin G-J, Lucassen WAM, et al. Diagnostic prediction models for suspected pulmonary embolism: systematic review and independent external validation in primary care. BMJ 2015; 351: h4438. doi:10.1136/bmj.h4438 DOI  
  26. Shen J-H, Chen H-L, Chen J-R, et al. Comparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism: a systematic review and meta-analysis. J Thromb Thrombolysis 2016; 41: 482-92. pmid:26178041 PubMed  
  27. Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA 2014; 311: 1117-24. pmid:24643601 PubMed  
  28. Ceriani E, Combescure C, Le Gal G et al. Clinical prediction rules for pulmonary embolism: a systematic review and metaanalysis. J Thromb Haemost 2010; 8: 957-70. PubMed  
  29. Gibson NS, Sohne M, Kruip MJ, et al. Further validation and simplification of the Wells clinical decision rule in pulmonary embolism. Thromb Haemost 2008; 99: 229-34. PubMed  
  30. The Task Force for the diagnosis and management of acute pulmonary embolism of the Eur Soc Card Guidelines on the diagnosis and management of acute pulmonary embolism (ESC). 2008; 29: 2276-2315.
  31. Bounemeaux H, Perrier A and Righini M. Diagnosis of venous thromboembolism: un update. Vasc Med 2010; 15: 399-406. PubMed  
  32. Geersing G-J, Erkens PMG, Lucassen WAM, 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. BMJ (DOI)  
  33. Pesavento R, de Conti G, Minotto I, et al; for the TACEP study.The value of 64-detector row computed tomography for the exclusion of pulmonary embolism. Thromb Haemost. 2011; 105. 901-7. PMID: 21301781 PubMed  
  34. ATS Guideline – Evaluation of Suspected Pulmonary Embolism in Pregnancy. Radiology 2012; 262 (2): 635-646
  35. Krishnan AS, Barrett T. Images in clinical medicine. Westermark sign in pulmonary embolism. N Engl J Med 2012; 366: e16. pmid:22417276 PubMed  
  36. Moore AJE, Wachsmann J, Chamarthy MR, et al. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther 2018; 8: 225-43. pmid:30057872 PubMed  
  37. Bajc M, Schümichen C, Grüning T, et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging 2019. pmid:31410539 PubMed  
  38. Shahir K, Goodman LR, Tali A, Thorsen KM, Hellman RS. Pulmonary embolism in pregnancy: CT pulmonary angiography versus perfusion scanning. Am J Roentgenol. 2010; 195 (3): W214-20
  39. Semb VB, Tveit A. Begrenset malignitetsutredning ved idiopatisk venøs trombose. Tidsskr Nor Legeforen 2014; 134: 407-11. doi:10.4045/tidsskr.13.0310 DOI  
  40. Delluc A, Antic D, Lecumberri R, et al. Occult cancer screening in patients with venousthromboembolism: guidance from the SSC of the ISTH. J Thromb Haemost. 2017; 15: 2076-9. pmid:28851126 PubMed  
  41. Wells PS, Forgie MA, Rodger MA. Treatment of venous thromboembolism. JAMA 2014; 311:717-28. doi: 10.1001/jama.2014.65. DOI  
  42. Kearon C, Akl EA. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood 2014; 123 (12): 1794-1801. doi: 10.1182/blood-2013-12-512681 DOI  
  43. Reikvam Å og Sandset PM. Warfarinbehandling i praksis – Tryggere antikoagulasjon. Skriftserie for leger 2010 (ISBN-13 978-82-8070-083-4).
  44. Segal JB, Streiff MB, Hofmann LV, Thornton K, Bass EB. Management of venous thromboembolism: a systematic review for a practice guideline. Ann Intern Med 2007; 146: 211-22. PubMed  
  45. Blondon M, Bounemeaux H, Righini M et al.Treatment strategies for acute pulmonary embolism. Expert Opin Pharmacother 2009; 10: 1159-71. PubMed  
  46. Colemen R and MacCallum P. Treatment and secondary prevention of venous thromboembolism in cancer. Br J C 2010; 102: Suppl 1: S17-23.
  47. Eichinger S and Kyrle PA. J. Duration of anticoagulation after initial idiopathic venous thrombosis – the swinging pendulum: Risk assessment to predict recurrence. Thromb Haemost 2009; 7: (suppl 1): 291-5.
  48. Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4: 4693-4738. pmid:33007077 PubMed  
  49. Venetz C, Jiménez D, Mean M, Aujesky D. A comparison of the original and simplified Pulmonary Embolism Severity Index. Thromb Haemost. 2011;106:423-8. doi: 10.1160/TH11-04-0263 DOI  
  50. Vandvik P (red.) Retningslinjer for antitrombotisk behandling og profylakse - 2020. Norsk Selskap for Trombose og Hemostase. v2.0. Publisert 27.05.2020. Siden lest 25.11.2020 app.magicapp.org  
  51. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease CHEST Guideline and Expert Panel Report. Chest 2016; 149: 315-52. pmid:26867832 PubMed  
  52. Helsedirektoratet. Statens legemiddelverk. Informasjon om warfarin og de nye perorale antikoagulasjonsmidlene dabigatran, rivaroksaban og apixaban. IS-2050. Versjon 2.0. November 2013
  53. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO; American College of Chest Physicians. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e691S-736S
  54. Rodina MT, Pendleton R, Wheeler M, Rodgers GM. The treatment of venous thromboembolism in special populations Thrombosis Research 2007; 119: 391-402. PubMed  
  55. Agnelli G, Becattini C, Meyer G, et al. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. N Engl J Med. 2020 Apr 23;382(17):1599-1607. PMID: 32223112 PubMed  
  56. Stevens SM, Woller SC, Bauer KA, et al. Guidance for the evaluation and treatment of hereditary and acquired thrombophilia. J Thromb Thrombolysis 2016; 41: 154-64. pmid:26780744 PubMed  
  57. Simes J, Becattini C, Agnelli G, et al. Aspirin for the Prevention of Recurrent Venous Thromboembolism: The INSPIRE Collaboration. Circulation. 2014 Sep 23;130(13):1062-71 PubMed  
  58. Geerts WH, Bergqvist D, Pineo GF et al. Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: S381-S453.
  59. Huo MH and Spyropoulis AC. The eighth American college of chest phycisians guidelines on venous thromboembolism prevention: implications for hospital prophylaxis strategies. J Thromb Thrombolysis 2010 (e-pub ahead of print).
  60. Ræder J og Nordentoft J. Dagkirurgi og anestesi. Tidsskr Nor Legeforen 2010; 130: 742-6. Tidsskrift for Den norske legeforening  
  61. Carrier M, Le Gal G, Wells PS et al. Systematic review: case-fatality rates of recurrent Venous Thromboembolism and major Bleeding Events Among Patients treated for venous Thromboembolism. Ann Intern Med 2010; 152: 578-89. Annals of Internal Medicine  
  62. Spyropoulus AC. To bridge or not to bridge: that’s the question. The argument FOR bridging therapy in patients on oral anticoagulants requiring temporary interruption for elective procedures. J Thromb Thrombolysis 2010; 29: 192-8. PubMed  
  63. Martinelli I, Lensing AW, Middeldorp S, et al. Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use. Blood 2016; 127: 1417-25. doi:10.1182/blood-2015-08-665927 DOI  
  64. Amorosi SL, Tsilimingras K, Thompson D, Fanikos John, Weinstein MC, Goldhaber SZ. Cost analysis of "Bridging Therapy" with Low-Molecular-Weight Heparin versus Unfractionated Heparin during temporary interruption of chronic anticoagulation. A J Cardiol 2004; 93: 509-11. PubMed  
  65. Klok FA and Huisman MV. Epidemiology and management of chronic thromboembolic pulmonary hypertension. Neth J Med 2010; 68: 347-351. PubMed  
  66. Rutherford O-CW, König MSS, Risnes K. Antidotbehandling ved bruk av direktevirkende antikoagulasjonsmidler. Tidsskr Nor Legeforen 2018. doi:10.4045/tidsskr.17.0190 DOI  
  67. Niessner A, Tamargo J, Morais J et al. Reversal strategies for non-vitamin K antagonist oral anticoagulants: a critical appraisal of available evidence and recommendations for clinical management-a joint position paper of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Working Group on Thrombosis. Eur Heart J 2017; 38: 1710 - 6. PMID: 26705385 PubMed  
  68. Roncon L, Zuin M, Casazza F, et al. Impact of syncope and pre-syncope on short-term mortality in patients with acute pulmonary embolism. Eur J Intern 2018. pmid:29655808 PubMed  
  69. Jervan Ø, Ghanima W. "Post lungeemboli syndrom" -en ny sykdomsbetegnelse?. Indremedisineren 2018. indremedisineren.no  
  70. Haukeland-Parker S, Jervan Ø, Johannessen HH, Gleditsch J, Stavem K, Steine K et al. Pulmonary rehabilitation to improve physical capacity, dyspnea, and quality of life following pulmonary embolism (the PeRehab study): study protocol for a two-center randomized controlled trial. Trials. 2021 Jan 6;22(1):22. PMID: 33407792 PubMed  
  71. 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 2005; 112: 416-22. Circulation  
  72. Sandset PM, Vandvik P (red.) Retningslinjer for antitrombotisk behandling og profylakse (2013, under oppdatering. Norsk Selskap for Trombose og Hemostase 2016. v1.2 published 10/12/16. Siden besøkt 12.03.2018
  73. Bikdeli B, Wang Y, Jimenez D, et al. Association of Inferior Vena Cava Filter Use With Mortality Rates in Older Adults With Acute Pulmonary Embolism. JAMA Intern Med 2018. pmid:30535318 PubMed  
  • Tore Amundsen, spesialist i indremedisin, lunge- og blodsykdommer, overlege Lungemedisinsk avdeling, St. Olavs hospital og professor ved NTNU
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL