Ceresetto José Manuel, Marques Marcos Arêas
Hospital Britânico de Buenos Aires, Buenos Aires, Argentina.
Universidade do Estado do Rio de Janeiro - UERJ, Hospital Universitário Pedro Ernesto - HUPE, Rio de Janeiro, RJ, Brasil.
J Vasc Bras. 2017 Apr-Jun;16(2):119-127. doi: 10.1590/1677-5449.007316.
Pulmonary thromboembolism remains a major therapeutic challenge for specialists and, despite investment and the consequent developments in diagnosis, prophylaxis, and treatment, the condition is still the leading cause of avoidable deaths in hospital settings. There is still great uncertainty with relation to the profile of patients who will actually benefit from systemic fibrinolytic treatment, without being exposed to serious risk of bleeding. There are tools that can help to identify patients who will benefit, including risk stratification and estimation of the prognosis of the event, with clinical scores for right ventricular failure, markers of right ventricular dysfunction and dilatation, and thrombotic mass assessment, whether alone or in combination. The only points of consensus with relation to fibrinolytic therapy for treatment of pulmonary thromboembolism are as follows: it should not be routinely indicated, none of the scores or markers alone should be used to justify its use, and patients with hemodynamic instability are the most likely to benefit. Furthermore, each case should be evaluated for risk of bleeding, especially central nervous system bleeding.
肺血栓栓塞症仍然是专家面临的一项重大治疗挑战，尽管在诊断、预防和治疗方面投入了资金并取得了相应进展，但在医院环境中，该病症仍是可避免死亡的主要原因。对于那些实际将从全身纤溶治疗中获益而又不面临严重出血风险的患者特征，仍存在很大的不确定性。有一些工具可帮助识别将获益的患者，包括风险分层和事件预后评估，使用右心室衰竭的临床评分、右心室功能障碍和扩张的标志物以及血栓块评估，无论是单独使用还是联合使用。关于肺血栓栓塞症纤溶治疗的唯一共识要点如下：不应常规使用；任何评分或标志物都不应单独用于证明其使用合理性；血流动力学不稳定的患者最有可能获益。此外，应对每个病例进行出血风险评估，尤其是中枢神经系统出血风险。
