Epidemiology, diagnosis, and therapy of pulmonary embolism.

Pulmonary embolism is a frequently observed clinical symptom. Its mortality rate is ca. 10 % und occurs mainly in the acute phasis. Immobilization, surgery, old age, malignancies, hormonal factors as well as inherited or acquired thrombophilia are important risk factors. Spiral computed tomography and ventilation-perfusion-scintigraphy are the decisive imaging methods. Pulmonary angiography is still the gold standard. The risk of pulmonary embolism could be lowered by 50 % through prophylaxis with unfractioned or low-molecular-weight heparin. The therapy of pulmonary embolism stratifies the clinical grade and reaches from ambulant therapy with low-molecular-weight heparin to thrombolysis or embolectomy in massive pulmonary embolism. Long-term anticoagulation, usually with vitamin-K-antagonists, should be applied according to the individual risk profile of the patient.

[1]  D. W. Barritt,et al.  Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. , 1960, Lancet.

[2]  E W Salzman,et al.  Management of heparin therapy: Controlled prospective trial. , 1975, The New England journal of medicine.

[3]  The relationship between the hemorrhagic and antithrombotic properties of low molecular weight heparin in rabbits. , 1982 .

[4]  B. Modan,et al.  Reduction of mortality in general medical in-patients by low-dose heparin prophylaxis. , 1982, Annals of internal medicine.

[5]  J. Hirsh,et al.  A comparison of the antithrombotic and haemorrhagic effects of low molecular weight heparin fractions: the influence of the method of preparation. , 1984, Thrombosis research.

[6]  R. Hull,et al.  Antithrombotic therapy for venous thromboembolic disease. , 1986, Chest.

[7]  Joan S. Reisch,et al.  Prevention of Venous Thromboembolism in General Surgical Patients: Results of Meta‐analysis , 1988, Annals of surgery.

[8]  R. Collins,et al.  Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. , 1988, The New England journal of medicine.

[9]  Michael J. Zappa,et al.  Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the prospective investigation of pulmonary embolism diagnosis , 1991 .

[10]  J. Vandenbroucke,et al.  Low-molecular-weight heparin versus standard heparin in general and orthopaedic surgery: a meta-analysis , 1992, The Lancet.

[11]  H R Büller,et al.  Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis. , 1992, The New England journal of medicine.

[12]  C. Schmid,et al.  Medical compared with surgical treatment for massive pulmonary embolism , 1994, The Lancet.

[13]  G. Simonneau,et al.  A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l'Embolie Pulmonaire. , 1997, The New England journal of medicine.

[14]  J. Daurès,et al.  Low molecular weight heparin and unfractionated heparin in thrombosis prophylaxis after major surgical intervention: Update of previous meta‐analyses , 1997, The British journal of surgery.

[15]  J. Viel,et al.  Comparative efficacy of a two-hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and hemodynamic outcome and one-year follow-up. , 1998, Journal of the American College of Cardiology.

[16]  F. Barral,et al.  A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. , 1998, The New England journal of medicine.

[17]  B A Carroll,et al.  The diagnostic approach to acute venous thromboembolism. Clinical practice guideline. American Thoracic Society. , 1999, American journal of respiratory and critical care medicine.

[18]  K. Mcintyre,et al.  Long-term benefit of thrombolytic therapy in patients with pulmonary embolism , 2000, Vascular medicine.

[19]  J. W. Henry,et al.  Fever in acute pulmonary embolism. , 2000, Chest.

[20]  G. Raskob,et al.  Sensitivity and Specificity of Helical Computed Tomography in the Diagnosis of Pulmonary Embolism , 2000, Annals of Internal Medicine.

[21]  M Gent,et al.  Derivation of a Simple Clinical Model to Categorize Patients Probability of Pulmonary Embolism: Increasing the Models Utility with the SimpliRED D-dimer , 2000, Thrombosis and Haemostasis.

[22]  J. Hirsh,et al.  Clinical Trials That Have Influenced the Treatment of Venous Thromboembolism: A Historical Perspective , 2001, Annals of Internal Medicine.

[23]  K. Bauer.  The Thrombophilias: Well-Defined Risk Factors with Uncertain Therapeutic Implications , 2001, Annals of Internal Medicine.

[24]  S. Findik,et al.  Low-Molecular-Weight Heparin versus Unfractionated Heparin in the Treatment of Patients with Acute Pulmonary Thromboembolism , 2002, Respiration.

[25]  G. Gamper,et al.  Chest Sonography in the Diagnosis of Pulmonary Embolism: A Comparison with MRI Angiography and Ventilation Perfusion Scintigraphy , 2002, Ultraschall in der Medizin.

[26]  J. Caniego,et al.  Prospective comparison of helical CT with angiography in pulmonary embolism: global and selective vascular territory analysis. Interobserver agreement , 2003, European Radiology.

[27]  S. Kreiner,et al.  Oral contraceptives and venous thromboembolism: a five-year national case-control study. , 2002, Contraception.

[28]  L. Melton,et al.  Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. , 2002, Archives of internal medicine.

[29]  M. Levine,et al.  Venous Thromboembolism and Cancer: Risks and Outcomes , 2003, Circulation.

[30]  M. Prins,et al.  Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. , 2003, The New England journal of medicine.

[31]  R. White,et al.  The epidemiology of venous thromboembolism. , 2003, Circulation.

[32]  C. Kearon,et al.  Natural History of Venous Thromboembolism , 2003, Circulation.

[33]  M Gent,et al.  Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. , 2003, The New England journal of medicine.

[34]  V. Tapson,et al.  The Evaluation of Suspected Pulmonary Embolism , 2003 .

[35]  Jonathan Dreyer,et al.  Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. , 2003, The New England journal of medicine.

[36]  Samuel Z Goldhaber,et al.  Spiral Computed Tomography for Acute Pulmonary Embolism , 2004, Circulation.