Tromboembolismo pulmonar: abordagem prática

Autores

  • Tiago Tribolet de Abreu Interno do Internato Complementar de Medicina Interna, Serviço de Medicina II, Hospitais Universitários de Coimbra
  • Maria José Galo Interna do Internato Geral, Serviço de Medicina II dos Hospitais da Universidade de Coimbra
  • José Correia Assistente Graduado de Medicina Interna, Serviço de Medicina II dos Hospitais da Universidade de Coimbra

Palavras-chave:

tromboembolismo pulmonar, diagnóstico, terapêutica, trombólise

Resumo

Introdução: O tromboembolismo pulmonar é uma situação frequente, com mortalidade elevada e de diagnóstico difícil. Nos últimos anos, surgiram alguns novos dados importantes para a sua abordagem diagnóstica e terapêutica.

Objectivos: Os autores procuraram rever o estado da arte desta patologia, incorporando os novos dados numa abordagem prática, diagnóstica e terapêutica, a dois tempos (no serviço de urgência e na enfermaria).

Resultados e conclusões: A abordagem diagnósti­ca no serviço de urgência desta situação deverá incidir sobre uma clínica, que é altamente sensível, embora pouco específica. A confirmação diagnóstica baseia-se em exames complementares, alguns deles realizáveis no serviço de urgência, mas outros só possíveis em segundo tempo. A terapêutica anticoagulante deverá ser iniciada de imediato, no serviço de urgência e mesmo antes da confirmação diagnóstica. A fibrinólise, nos casos específicos em que está indicada, diminui a mortalidade e a morbilidade.

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Referências

Skibo L, Goldhaber SZ. Diagnosis of acute pulmonary embolism. ln: Goldhaber SZ. ed. Cardiopulmonary diseases and cardiac tumors. Vol. 3 of Atlas of heart diseases. Philadelphia: Current Medicine, I 995: 2.1-2.31.

Koonin LM, Atrash HK, Lawson HW, Smith JC. Maternal mortality surveillance. United States, 1979-1986. MMWR CDC Surveill Summ 1991: 40 (SS-2): l-13.

Anderson FAJr. Wheeler HB. Goldberg RJ et ai. A population-based perspective of lhe hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study. Arch lntern Med 1991: 151: 933-938.

Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ III. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch lntern Med 1998: 158: 585-593.

Palia A, Giuntini C. lmaging of pulmonary embolism. ln: Morpurgo M, ed. Pulmonary embolism: a WHO/ISFC task force perspective. New York: Marcel Dckker, 1994; 115-151

Moser KM. Pulmonary thromboembolism. ln: Wilson JD. Braunwald E. lsselbachcr KJ. Petersdorf RG. Martin JB, Fauci AS. Root RK. eds. Harrison's principies of internai medicine. lnternational Edition: McGraw-Hill. 1991: 1090-1096.

Wolfe WG, Sabiston DC Jr. Pulmonary embolism. Philadelphia: Saunders, 1980: 98-99.

Ashby EC. Leg elevation in prophylaxis of thromboembolism (letter). Lancei 1993; 342:1562-1563.

Palia A, Petruzzelli S, Donnamaria V, Giuntini C. The role of suspicion in the diagnosis of pulmonary embolism. Chest 1995; 107: 21S-24S.

Bergqvist D, Lindblad B. A 30-year survey of pulmonary embolism verified at autopsy: an analysis of 1274 surgical patients. Br J Surg 1985; 72: 105-108.

Cott EM, Laposata M. Laboratory evaluation of hypercoagulable states. Hematology/Oncology Clinics of North America 1998; 12 (6): 1141-1166

Comp PC, Thurnau GR, Welsh J. Esmon CT. Functional and immunologic protein S levels are decreased during pregnancy. Blood 1986; 68:881-885.

Alving BM, Comp PC. Recent advances in understanding clotting and evaluating patients with recurrent thrombosis. Am J Obstei Gynecol 1992; 167: 1184-1191·.

Goldhaber SZ. Pulmonary embolism. N Eng! J Med 1998; 339: 93-104.

Handin RI. Disorders of coagulation and thrombosis. ln: Fauci AS, Braunwald E. Isselbacher KJ, Wilson J, Martin JB, Kasper DL, Hauser SL, Longo DN, eds. Harrison 's principies of internai medicine. McGraw-Hill, 1998: 736-743.

Rees DC, Cox M, Clegg JB. World distribution of factor V Leiden. Lancei 1995; 346: 1133-1134.

D'Angelo A, Selhub J. Homocystcine and thrombotic disease. Blood 1997; 90: 1-11.

Khamashta MA, Cuadrado MJ, Mujic F, Taub NA, Hunt BJ, Hughes GRV. The management of thrombosis in the antiphospholipid­ antibody syndrome. N Engl J Med 1995; 332: 993-997.

Simons GR, Goldhaber SZ, Elliott CG, et ai. Quantitative plasma D-dimer leveis among patients undergoing pulmonary angiography for suspected pulmonary embolism. JAMA 1993; 270: 2819-2822.

Cvitanic O, Marino PL. lmproved use of arterial blood gas analysis in suspected pulmonary embolism: Chest 1989; 95: 48-51.

Stein PD, Goldhaber SZ, Henry JW. Miller AC. Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism. Chest 1996; 109: 78-81.

McGinn S, White PD. Acute cor pulmonale resulting from pulmonary embolism. JAMA 1935; 104: 1473-1480.

Durant TM, Ginsburg IW, Roesler H. Transient bundle branch block and other electrocardiographic changes in pulmonary embolism. Am Heart J 1939; 17: 423-430.

Wood P. Pulmonary embolism: diagnosis by chest lead electrocardiography. Br Heart J 1941; 3: 21-29.

Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson T, Weg JG. Clinicai, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991; 100: 598-603.

Ferrari E, lmbert A, Chevalier T, Mihoubi A, Morand P, Baudouy M. The ECG in pulmonary embolism: predictive value of negative T waves in precordial leads-80 case reports. Chest 1997; 111: 537-543.

Westermark N. On the roentgen diagnosis of lung embolism. Acta Radiol 1938; 19: 357-372.

Hampton AO, Castleman B. Correlation of post-mortem chest teleroentgenograms with autopsy findings: pulmonary embolism and infarction. Am J Roentgenol 1940; 43: 305.

Fraser RG, Pare JAP, Pare PD, et ai. Diagnosis of diseases of the chest. Philadelphia: WB Saunders. 1990: 839.

Goldhaber SZ. Pulmonary thromboemholism._ ln: Fauci AS, Braunwald E, Isselbacher KJ, Wilson J, Martin JB, Kasper DL, Hauser SL, Longo DN, eds. Harrison 's principies of internai medicine. McGraw-Hill, 1998: 1469-1472.

Lualdi JC, Goldhaber SZ. Right ventricular dystimction after acute pulmonary embolism: Pathophysiologic factors, detection, and therapeutic implications. Am Heart J 1995; 130: 1276-1282.

The PIOPED lnvestigators. Value of lhe ventilation/perfusion scan in acute pulmonary embolism. JAMA I 990; 263: 2753- 2759.

Stein PD, Athanasoulis C, Alavi A, et ai. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 1992; 85: 462-468.

Remy-Jardin M, Remy J, Wattinne L, Giraud F. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique - comparison with pulmonary angiography. Radiology 1992; 185: 381-387.

Drucker EA, Rivitz SM, Shepard JO, et al. Acute pulmonary embolism: assessment of helical CT for diagnosis. Radiology 1998; 209: 235-241.

Wolfe MW, Lee RT, Feldstein ML, Parker JA, Come PC, Goldhaber SZ. Prognostic Significance of right ventricular hypokinesis and perfusion lung scan defects in pulmonary embolism. Am Heart J 1994; 127: 1371-1375.

Rosenow EC. Venous and pulmonary thromboembolism: an algorithmic approach to diagnosis and management. Mayo Clin Proc 1995; 70: 45-49.

Weitz Jl. Low-molecular-weight heparins. N Engl J Med 1997; 337: 688-698.

Goldhaber SZ. Treatment of acute pulmonary embolism. ln: Goldhaber SZ. ed. Cardiopulmonary diseases and cardiac tumors. Vol. 3 of Atlas of heart diseases. Philadelphia: Current Medicine, 1995: 3.1-3.25.

Decousus H, Leizorovicz A, Parent F, et ai. A clinicai trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med 1998; 338: 409-415.

Goldhaber SZ. Contemporary pulmonary embolism thrombolysis. Chest 1995; 107: 45S-5 IS.

Goldhaber SZ, Agnelli G, Levine MN on behalf of the Bolus Alteplase Pulmonary Embolism Group. Reduced dose bolus alteplase vs conventional alteplase infusion for pulmonary embolism thrombolysis. An international multicenter randomized trial. Chest 1994; 106: 718-724.

Meyer G, Tamisier D. Reynaud P, Hervé S. Acute pulmonary embolectomy. ln: Goldhaber SZ. ed. Cardiopulmonary diseases and cardiac tumors. Vol. 3 of Atlas of heart diseases. Philadelphia: Current Medicine, 1995: 6.1-6.12.

Daily P. Pulmonary thromboendarterectomy. ln: Goldhaber SZ. ed. Cardiopulmonary diseases and cardiac tumors. Vol. 3 of Atlas of heart diseases. Philadelphia: Current Medicine, 1995: 8.1-8.1O.

Fedullo PF, Auger WR, Channick RN, Jamieson SW, Moser KM. A multidisciplinary approach to chronic thromboembolic pulmonary hypertension. ln: Goldhaber SZ. ed. Cardiopulmonary diseases and cardiac tumors. Vol. 3 of Atlas of heart diseases. Philadelphia: Current Medicine, 1995: 7.1-7.25.

Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med 1992; 326: 1240-1245.

Rance A, Emmerich J, Oger E, Fiessinger JN. Maladie thrombo­ embolique veineuse et cancers occultes: quel bilan réaliser? À propos de 204 patients. Arch Mal Coeur 1997; 90: 209-214.

Prins MH, Lensing AWA, Hirsh J. ldiopathic deep venous thrombosis. Is a search for malignant disease justitied? Arch lntern Med 1994; 154: 1310-1312.

Green KB, Silverstein RL. Hypercoagulability in cancer. Hematology/Oncology Clinics North Am 1996;1 O: 499-512.

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Publicado

31-03-2000

Como Citar

1.
Tribolet de Abreu T, Galo MJ, Correia J. Tromboembolismo pulmonar: abordagem prática. RPMI [Internet]. 31 de Março de 2000 [citado 25 de Fevereiro de 2024];7(1):35-41. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/1967

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