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Embolia pulmonar

Última revisión: 9 Aug 2025
Última actualización: 26 Sep 2023

Resumen

Definição

História e exame físico

Principais fatores diagnósticos

  • presencia de factores de riesgo
  • dolor torácico
  • disnea
  • taquipnea
  • presíncope o síncope
  • hipotensión (presión arterial sistólica <90 mmHg)
Detalhes completos

Outros fatores diagnósticos

  • sensación de ansiedad
  • tos
  • taquicardia
  • fiebre
  • hinchazón/sensibilidad unilateral de la pantorrilla
  • hemoptisis
  • aumento de la presión venosa yugular
  • desplazamiento esternal
  • componente pulmonar acentuado de S2
Detalhes completos

Fatores de risco

  • diagnóstico de trombosis venosa profunda (TVP)
  • cirugía mayor en los 3 meses anteriores
  • hospitalización médica en los últimos 2 meses
  • cáncer activo
  • evento tromboembólico venoso previo
  • traumatismo o fractura recientes
  • mayor edad
  • embarazo y posparto
  • venas varicosas
  • parálisis de las extremidades inferiores
  • trombofilias hereditarias
  • mutación del factor V de Leiden
  • mutación del gen G20210A de la protrombina
  • deficiencia de proteína C y proteína S
  • deficiencia de antitrombina
  • síndrome de anticuerpos antifosfolípidos
  • comorbilidades médicas
  • el uso de fármacos específicos
  • obesidad (índice de masa corporal [IMC] ≥29 kg/kg/m²)
  • tabaquismo
  • viaje reciente de larga duración
  • antecedentes familiares de tromboembolia venosa (TEV)
  • cateterismo venoso central
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • Criterios para descartar embolismo pulmonar (PERC)
  • Criterios de Wells/puntuación de Ginebra/criterios YEARS
  • Prueba del dímero D
  • angiografía pulmonar por tomografía computarizada (APTC) con detector múltiple
  • gammagrafía de ventilación-perfusión (V/P)
  • estudios de coagulación
  • urea y creatinina, pruebas de función hepática
  • hemograma completo (HC)
Detalhes completos

Investigações a serem consideradas

  • Ecografía en el punto de atención (POCUS)
  • radiografía de tórax
  • angiografía por resonancia magnética (ARM)
  • angiografía pulmonar
  • ecocardiografía transtorácica (ETT)
  • electrocardiograma (ECG)
  • gasometría arterial (GSA)
  • cribado de trombofilia
  • ecografía
  • troponina
Detalhes completos

Algoritmo de tratamento

AGUDA

EP de alto riesgo (masiva) o alta probabilidad clínica de EP con shock o hipotensión (es decir, presión arterial sistólica < 90 mmHg), sin contraindicación para la anticoagulación o la trombólisis

riesgo alto o riesgo intermedio-alto, contraindicación para la anticoagulación o la trombólisis

riesgo intermedio-alto escala PESI/sPESI, sin contraindicación para la anticoagulación o la trombólisis

riesgo intermedio-bajo o riesgo bajo en la escala PESI/sPESI, sin contraindicación para la anticoagulación

riesgo intermedio-bajo o riesgo bajo en la escala PESI/sPESI, con contraindicación para la anticoagulación

CONTÍNUA

EP confirmada: provocada

EP confirmada: no provocada

EP confirmada: embarazada

EP confirmada: asociada al cáncer

EP confirmada: EP recurrente durante el tratamiento con anticoagulación

Colaboradores

Autores

Scott Stevens, MD

Director

Thrombosis Clinic

Intermountain Medical Center

Murray

Professor of Medicine

Department of Medicine

Intermountain Healthcare and University of Utah

Salt Lake City

UT

Declarações

SS declares that he has no competing interests.

Scott C. Woller, MD

Director

Thrombosis Clinic

Intermountain Medical Center

Murray

Professor of Medicine

Department of Medicine

Intermountain Healthcare and University of Utah

Salt Lake City

UT

Declarações

SCW declares that he is expecting to receive funding of an investigator initiated grant from Janssen Pharmaceuticals to Intermountain Health with no direct compensation to himself for research in the sum of $500,000 in 2024.

Gabriel V. Fontaine, PharmD, MBA, BCPS

Clinical Pharmacy Manager

Critical Care and Emergency Medicine

Advanced Clinical Pharmacist

Neuroscience Critical Care

Intermountain Medical Center

Murray

UT

Declarações

GVF has received consulting fees and honoraria from AstraZeneca, Chiesi, and Anticoagulation Forum.

Agradecimentos

Dr Scott M. Stevens, Dr Scott C. Woller, and Dr Gabriel V. Fontaine would like to gratefully acknowledge Drs Geno Merli, Luis H. Eraso, Taki Galanis, Geoffrey Ouma, Miguel Angel de Gregorio, Alicia Laborda, and Seth W. Clemens, previous contributors to this topic.

Declarações

GM has received grants or research support from BMS, J&J, Sanofi-Aventis, Portola, and Janssen; he has served as a Scientific Consultant for BMS, J&J, and Sanofi-Aventis. LHE, TG, GO, MAG, AL, and SWC declare that they have no competing interests.

Revisores

Keith Wille, MD, MSPH

Associate Professor of Medicine

University of Alabama at Birmingham

Birmingham

AL

Declarações

KW declares that he has no competing interests.

John R. Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

C.S. Mott Children's Hospital

Ann Arbor

MI

Declarações

JRC declares that he has no competing interests.

Sanjeev Wasson, MD

Advanced Clinical Fellow

Cleveland Clinic Foundation

Cleveland

OH

Declarações

SW declares that he has no competing interests.

David Jimenez, MD, PhD

Respiratory Physician and Associate Professor

Ramón y Cajal Hospital and Alcalá de Henares University

Respiratory Department and Medicine Department

Madrid

Spain

Declarações

DJ has received consulting fees from Boehringer Ingelheim, Bayer, Leo-Pharm, and Rovi, and lecture fees from Sanofi Aventis.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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). Eur Heart J. 2020 Jan 21;41(4):543-603.Texto completo

Stevens SM, Woller SC, Baumann Kreuziger L, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. 2021 Dec;160(6):e545-608.Texto completo  Resumo

American College of Radiology. ACR Appropriateness Criteria®: suspected pulmonary embolism. 2022 [internet publication].Texto completo

Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018 Nov 27;2(22):3317-59.Texto completo  Resumo

Stevens SM, Woller SC, Baumann Kreuziger L, et al. Antithrombotic therapy for VTE disease: compendium and review of CHEST guidelines 2012-2021. Chest. 2024 Aug;166(2):388-404.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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