Tromboembolia pulmonar

Abstract

Pulmonary embolism is a disease characterized by the dislodgement of thrombus from the peripheral venous system, reaching the pulmonary circulation. Pulmonary embolism demands an interdisciplinary work, involving medical specialties, surgical staff and interventional radiologists. This review focuses the posterior events from deep vein thrombosis (DVT), considered today part of the same disease. Rudolph Virchow described more than 140 years ago the risk factors that could trigger pulmonary embolism (vascular stasis, hipercoagulability and endothelial trauma). The incidence is 1/1,000 per year in United States, with more than 250,000 hospitalizations and more than 50,000 deaths annually, the mortality rate in patients being hospitalized is 15% in the last 40 years, unfortunately in Mexico we do not have epidemiological data regarding pulmonary embolism. Pathophysiologically there is an acute increased arterial pulmonary pressure and pulmonary vascular resistance, taking the heart to progressive right ventricular failure (acute cor pulmonale). The diagnosis of pulmonary embolism is suspected since the beginning of the approach, because the patients appear with non-specific symptoms and signs, laboratory, electrocardiographic and radiologic studies are needed to make therapeutic decisions, pulmonary arteriography is the gold standard for the diagnosis of pulmonary embolism. Heparin constitutes the cornerstone of management, and it can be unfractionated heparin or low molecular weight heparins, today the low molecular weight heparins have showed similar efficacy as unfractionated heparin, with the advantage of less incidence of adverse events. This article also focuses in the precise indications of patients suitable to receive thrombolytic therapy.