Gå direkt till huvudinnehållet

Lungemboli

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition:
Lungemboli, LE, är en ocklusion (blodpropp) i en eller flera lungartärer, oftast som led i venös tromboembolism (emboli från DVT).
Förekomst:
Incidensen LE i Sverige är cirka 65 per 100 000 invånare och år. Incidensen ökar med stigande ålder, och är bland personer >80 år 300–400 per 100 000 invånare och år.
Symtom:
Symtombilden skiljer sig mycket och har ett brett spektrum från lätt rethosta, akut svår andnöd och till plötslig död.
Kliniska fynd:
Takypné av olika grad, eventuellt chocksymtom; gråblek och fuktig hud, svag och snabb puls och lågt blodtryck hos medtagen och orolig patient.
Diagnostik:
Kompletterande undersökningar är D-dimer, EKG, DT lungartärer eller lungskintigrafi.
Behandling:
Akutbehandling med heparin eller NOAK, eventuellt trombolys. NOAK är förstahandsval som sekundärprofylax.
  1. 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. PMID: 31473594 PubMed  
  2. Baksaas ST, Geiran OR, Iversen S. Kirurgi ved kronisk lungeemboli. Tidsskr Nor Lægeforen 2001; 121: 431-3. tidsskriftet.no  
  3. Socialstyrelsen. Statistikdatabas för diagnoser i sluten vård. Lungemboli. Hämtad 2018-01-24 sdb.socialstyrelsen.se  
  4. 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  
  5. 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  
  6. 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  
  7. 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  
  8. Andreassen AK. Kronisk tromboembolisk pulmonal hypertensjon. Hjerteforum 2016; 29 (nr. 3): 19-25. www.legeforeningen.no  
  9. 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  
  10. 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  
  11. Zöller B, Xinjun L, Sundquist J, Sundquist K. Risk of pulmonary embolism in patients with autoimmune disorders: a nationwide follow-up study from Sweden. Lancet 2011; : DOI:10.1016/S0140-6736(11)61306-8. DOI  
  12. Trigg DE, Wood MG, Koides PA et al. Hormonal Influences on Haemostasis in Women. Sem Thromb Haemost 2011; 37: 77-86. PubMed  
  13. 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  
  14. Olie V, canonico M, Scarabin P-Y. Postmenopausal hormone therapy and venous thromboembolism. Thrombosis Res 2011 (E-Pub ahead of print).
  15. 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  
  16. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ 2019; 364: k4810. doi:10.1136/bmj.k4810 DOI  
  17. Bourjeily G, Paidas M, Khalil H, Rosene-Montella K, Rodger M. Pulmonary embolism in pregnancy. The Lancet 2009; 375: 500-12. The Lancet  
  18. Deneux-Tharaux C, saucedo M, Bouvier-Colle MH. Pulmonary embolism in pregnancy. The Lancet 2010; 375: 1778-9. The Lancet  
  19. Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med 2002; 346: 752-63. New England Journal of Medicine  
  20. Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med 2010 Nov 6. Epub ahead of print.
  21. Watson HG and Baglin TP. Guidelines on travel-related venous thrombosis. BJH 2011; 152: 31-34. PubMed  
  22. 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  
  23. Shen J-H, Chen H-L, Chen J-R, et al. Comparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism: a systematic review and meta-analysis. J Thromb Thrombolysis 2016; 41: 482-92. pmid:26178041 PubMed  
  24. 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  
  25. Ceriani E, Combescure C, Le Gal G et al. Clinical prediction rules for pulmonary embolism: a systematic review and metaanalysis. J Thromb Haemost 2010; 8: 957-70. PubMed  
  26. 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  
  27. Lungemboli (LE). Janusinfo, Region Stockholm. Hämtad 2020-03-09 janusinfo.se  
  28. 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  
  29. 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  
  30. Prandoni P, Lensing AWA, Prins MH et al. Prevalence of pulmonary embolism among patients hospitalized for syncope. N Engl J Med 2016; 375: 1524 – 31. pmid: 27797317 PubMed  
  31. 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  
  32. 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  
  33. Shahir K, Goodman LR, Tali A, et al. Pulmonary embolism in pregnancy: CT pulmonary angiography versus perfusion scanning. Am J Roentgenol. 2010; 195 (3): W214-20. PMID: 20729418 PubMed  
  34. Läkemedelsbehandling av venös trombos. Janusinfo Region Stockholm. Hämtad 2020-03-10 janusinfo.se  
  35. 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  
  36. Wells PS, Forgie MA, Rodger MA. Treatment of venous thromboembolism. JAMA 2014; 311:717-28. doi: 10.1001/jama.2014.65 DOI  
  37. Kearon C, Akl EA. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood 2014; 123 (12): 1794-1801. doi: 10.1182/blood-2013-12-512681 DOI  
  38. Lungemboli. Nationellt kliniskt kunskapsstöd. Hämtad 2022-07-15. nationelltklinisktkunskapsstod.se  
  39. Segal JB, Streiff MB, Hofmann LV, Thornton K, Bass EB. Management of venous thromboembolism: a systematic review for a practice guideline. Ann Intern Med 2007; 146: 211-22. PubMed  
  40. Blondon M, Bounemeaux H, Righini M et al.Treatment strategies for acute pulmonary embolism. Expert Opin Pharmacother 2009; 10: 1159-71. PubMed  
  41. Colemen R and MacCallum P. Treatment and secondary prevention of venous thromboembolism in cancer. Br J C 2010; 102: Suppl 1: S17-23.
  42. Eichinger S and Kyrle PA. J. Duration of anticoagulation after initial idiopathic venous thrombosis – the swinging pendulum: Risk assessment to predict recurrence. Thromb Haemost 2009; 7: (suppl 1): 291-5.
  43. Shirley M, Dhillon S. Edoxaban: A Review in Deep Vein Thrombosis and Pulmonary Embolism. Drugs. 2015 Nov;75(17):2025-34. PMID:26546477. PubMed  
  44. Benjamin D Fox, Susan R Kahn, David Langleben et al. Efficacy and safety of novel oral anticoagulants for treatment of acute venous thromboembolism: direct and adjusted indirect meta-analysis of randomised controlled trials. BMJ. 2012; 345: e7498 PubMed  
  45. Robertson L, Kesteven P, McCaslin JE. Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of deep vein thrombosis. Cochrane Database Syst Rev. 2015 Jun 30;6:CD010956. doi: 10.1002/14651858.CD010956.pub2 DOI  
  46. Själander S, Själander A. NOAK vid venös tromboembolism samt hantering av blödningar. Lakartidningen.se 2018-12-04. www.lakartidningen.se  
  47. Dosering av lågmolekylärt heparin, fondaparinux och perorala antikoagulantia vid behandling av venös tromboembolism hos patienter med övervikt respektive undervikt, Janusinfo, region Stockholm, 2021-06-03 janusinfo.se  
  48. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d`Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 2005; 112: 416-22. Circulation  
  49. Bikdeli B, Wang Y, Jimenez D, et al. Association of Inferior Vena Cava Filter Use With Mortality Rates in Older Adults With Acute Pulmonary Embolism. JAMA Intern Med 2018. pmid:30535318 www.ncbi.nlm.nih.gov  
  50. Geerts WH, Bergqvist D, Pineo GF et al. Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: S381-S453.
  51. Huo MH and Spyropoulis AC. The eighth American college of chest phycisians guidelines on venous thromboembolism prevention: implications for hospital prophylaxis strategies. J Thromb Thrombolysis 2010 (e-pub ahead of print).
  52. Stanley A and Young A. Primary prevention of thromboembolism in medical and surgical oncology patients. BJC 2010; 102; S10-16.
  53. 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  
  54. 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  
  55. Amorosi SL, Tsilimingras K, Thompson D, Fanikos John, Weinstein MC, Goldhaber SZ. Cost analysis of "Bridging Therapy" with Low-Molecular-Weight Heparin versus Unfractionated Heparin during temporary interruption of chronic anticoagulation. A J Cardiol 2004; 93: 509-11. PubMed  
  56. Klok FA and Huisman MV. Epidemiology and management of chronic thromboembolic pulmonary hypertension. Neth J Med 2010; 68: 347-351. PubMed  
  57. Pollack CV, Reilly PA, van Ryn J, et al. Idarucizumab for dabigatran reversal - full cohort analysis. N Engl J Med 2017; 377: 431-441. PMID: 28693366 PubMed  
  58. Rutherford O-CW, König MSS, Risnes K. Antidotbehandling ved bruk av direktevirkende antikoagulasjonsmidler. Tidsskr Nor Legeforen 2018. doi:10.4045/tidsskr.17.0190 DOI  
  59. Niessner A, Tamargo J, Morais J et al. Reversal strategies for non-vitamin K antagonist oral anticoagulants: a critical appraisal of available evidence and recommendations for clinical management-a joint position paper of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Working Group on Thrombosis. Eur Heart J 2017; 38: 1710 - 6. PMID: 26705385 PubMed  
  60. Donzé J, Le Gal G, Fine MJ, et al. Prospective validation of the Pulmonary Embolism Severity Index. A clinical prognostic model for pulmonary embolism. Thromb Haemost 2008; 100: 943-8. PubMed  
  61. Yamashita Y, Morimoto T, Amano H, et al. Validation of simplified PESI score for identification of low-risk patients with pulmonary embolism: From the COMMAND VTE Registry published online ahead of print, 2018 Sep 11. Eur Heart J Acute Cardiovasc Care. 2018;2048872618799993. PMID: 30203659 PubMed  
  • Peter J Svensson, professor och överläkare, Koagulationscentrum, Skånes universitetssjukhus
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet