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Diagnose, Therapie und Sekundärprophylaxe der akuten Lungenembolie

Vorstellung und Kommentierung der neuen Leitlinien der ESC 2008

Diagnosis, therapy and secondary prophylaxis of acute pulmonary embolism

Presentation of and commentary on the new ESC 2008 guidelines

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Zusammenfassung

Die akute venöse Thrombembolie gehört zu den häufigen kardiovaskulären Notfällen, bei etwa 1/3 der Patienten liegt eine Lungenembolie (LE) vor. Bei einer durchschnittlichen Letalitätsrate von 11% innerhalb der ersten 2 Wochen nach Diagnosestellung versterben in Deutschland schätzungsweise bis zu 40.000 Patienten jährlich an einer LE. Damit kommt deren Diagnose und Therapie entscheidende Bedeutung zu, weshalb bereits 2000 von der Europäischen Gesellschaft für Kardiologie Leitlinien zur Diagnose und Therapie der LE veröffentlicht wurden. Im vorliegenden Beitrag werden die 2008 gegenüber der Version aus 2000 aktualisierten und erweiterten Punkte, 1. initiale Risikostratifizierung – bereits bei Verdacht auf Lungenembolie, 2. diagnostische Verfahren und Algorithmen, 3. weiterführende Risikostratifizierung, 4. therapeutische Strategien in der Akutphase, 5. weiteres Management und 6. Langzeitantikoagulation und Sekundärprophylaxe, vorgestellt und besprochen.

Abstract

Acute venous thromboembolism is a common cardiovascular emergency. Acute pulmonary embolism (PE) is present in one third of these patients. With an average lethality rate of 11% within the first two weeks following diagnosis, approximately 40,000 patients in Germany die annually as a result of PE; therefore, their diagnosis and therapy is of particular importance. For this reason, the European Society of Cardiology published guidelines on diagnosis and therapy in 2000. The current article presents and discusses the points as updated and extended in the 2008 version of the guidelines, including: (1) initial risk stratification – when PE is already suspected; (2) diagnostic procedures and algorithms; (3) further risk stratification; (4) therapeutic strategies in the acute phase; (5) further management and (6) long-term anticoagulation and secondary prophylaxis.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    A. Walther & A. Schellhaaß

  2. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, Köln, Deutschland

    B.W. Böttiger

  3. Abteilung Kardiologie und Pneumologie, Universitätsmedizin Göttingen, 37099, Göttingen, Deutschland

    S. Konstantinides

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  1. A. Walther
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  2. A. Schellhaaß
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  3. B.W. Böttiger
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  4. S. Konstantinides
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Correspondence to S. Konstantinides.

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Walther, A., Schellhaaß, A., Böttiger, B. et al. Diagnose, Therapie und Sekundärprophylaxe der akuten Lungenembolie. Anaesthesist 58, 1048–1054 (2009). https://doi.org/10.1007/s00101-009-1616-y

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