Lungeemboli (LE)
Sist oppdatert: Sist revidert:
Sist revidert av:Tore Amundsen
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:
Klinisk mistanke (brystsmerter, tung pust), Wells skår, vurder D-dimer. 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
- 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
- Baksaas ST, Geiran OR, Iversen S. Kirurgi ved kronisk lungeemboli. Tidsskr Nor Lægeforen 2001; 121: 431-3. tidsskriftet.no
- Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis 2016; 41: 3-14. pmid:26780736 PubMed
- 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
- 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
- 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
- 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
- Andreassen AK. Kronisk tromboembolisk pulmonal hypertensjon. Hjerteforum 2016; 29 (nr. 3): 19-25. www.legeforeningen.no
- 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
- 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
- Stanley A and Young A. Primary prevention of thromboembolism in medical and surgical oncology patients. BJC 2010; 102; S10-16.
- Goldhaber SZ.Risk factors for venous thromboembolism. J Am Coll Cardiol 2010; 56: 1-7. PubMed
- la Roi-Teeuw HM, van Smeden M, Bos B, et al. Estimated causal effects of common respiratory infections on cardiovascular risk: a meta-analysis. Open Heart 2023. pmid:38016788 PubMed
- 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
- 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
- Trigg DE, Wood MG, Koides PA et al. Hormonal Influences on Haemostasis in Women. Sem Thromb Haemost 2011; 37: 77-86. PubMed
- 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
- Olie V, canonico M, Scarabin P-Y. Postmenopausal hormone therapy and venous thromboembolism. Thrombosis Res 2011 (E-Pub ahead of print).
- 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
- Deneux-Tharaux C, saucedo M, Bouvier-Colle MH. Pulmonary embolism in pregnancy. The Lancet 2010; 375: 1778-9. The Lancet
- Hervig T, Haram K, Sandset PM. Dyp venetrombose hos gravide. Tidsskr Nor Lægeforen 1998; 118: 4093-7. PubMed
- Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med 2002; 346: 752-63. New England Journal of Medicine
- Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med 2010 Nov 6. Epub ahead of print.
- Watson HG and Baglin TP. Guidelines on travel-related venous thrombosis. BJH 2011; 152: 31-34. PubMed
- Wells PS. Integrated strategies for the diagnosis of venous thromboembolism. J Thromb Haemost 2007; 5 (suppl. 1): 41-50.
- 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
- 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
- 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
- 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)
- ATS Guideline – Evaluation of Suspected Pulmonary Embolism in Pregnancy. Radiology 2012; 262 (2): 635-646
- Krishnan AS, Barrett T. Images in clinical medicine. Westermark sign in pulmonary embolism. N Engl J Med 2012; 366: e16. pmid:22417276 PubMed
- 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
- 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
- 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
- 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
- Semb VB, Tveit A. Begrenset malignitetsutredning ved idiopatisk venøs trombose. Tidsskr Nor Legeforen 2014; 134: 407-11. doi:10.4045/tidsskr.13.0310 DOI
- 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
- Reikvam Å og Sandset PM. Warfarinbehandling i praksis – Tryggere antikoagulasjon. Skriftserie for leger 2010 (ISBN-13 978-82-8070-083-4).
- 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
- 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
- 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
- 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
- Rodina MT, Pendleton R, Wheeler M, Rodgers GM. The treatment of venous thromboembolism in special populations Thrombosis Research 2007; 119: 391-402. PubMed
- McBane 2nd RD, Wysokinski WE, Le-Rademacher JG, et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism. The ADAM VTE Trial. J Thromb Haemostat 2020; 18: 411-421. PMID: 31630479 PubMed
- 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
- 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
- Planer D, Yanko S, Matok I, et al. Catheter-directed thrombolysis compared with systemic thrombolysis and anticoagulation in patients with intermediate- or high-risk pulmonary embolism: Systematic review and network meta-analysis. CMAJ 2023; 195: E833-E843. PMID: 37336568 PubMed
- 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
- 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
- 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
- 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
- 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
- Jervan Ø, Ghanima W. "Post lungeemboli syndrom" -en ny sykdomsbetegnelse?. Indremedisineren 2018. indremedisineren.no
- 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
- Tore Amundsen, spesialist i indremedisin, lunge- og blodsykdommer, overlege Lungemedisinsk avdeling, St. Olavs hospital og professor ved NTNU
- Ingard Løge, spesialist allmennmedisin, redaktør NEL