Última revisión: 18 Mayo 2021
Última actualización: 09 Jul 2018

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

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

Otros factores de diagnóstico

  • 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

Factores de riesgo

  • 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
  • parálisis de las extremidades inferiores
  • 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 en avión de larga distancia reciente
  • antecedentes familiares de tromboembolia venosa (TEV)
  • cateterismo venoso central

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • Criterios de Wells/ escala de Ginebra
  • 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)
  • Criterios para descartar embolismo pulmonar (PERC)
  • Prueba del dímero D

Pruebas diagnósticas que deben considerarse

  • radiografía de tórax
  • angiografía por resonancia magnética (RM)
  • angiografía pulmonar
  • electrocardiograma (ECG)
  • gasometría arterial (GSA)
  • cribado de trombofilia
  • ecografía
  • criterios YEARS
  • troponina

Algoritmo de tratamiento

Colaboradores

Director

Thrombosis Clinic

Intermountain Medical Center

Murray

UT

Professor of Medicine

Department of Medicine

Intermountain Healthcare and University of Utah

Salt Lake City

UT

Divulgaciones

SS is an unpaid panel co-chair for the American College of Chest Physicians, evidence-based guideline for management of venous thromboembolism. SS was co-investigator for an investigator-initiated clinical trial of apixaban, which was funded by Pfizer/BMS and concluded less than 36 months ago. This activity produces no personal income, but funds were paid to his institution.

Director

Thrombosis Clinic

Intermountain Medical Center

Murray

UT

Professor of Medicine

Department of Medicine

Intermountain Healthcare and University of Utah

Salt Lake City

UT

Divulgaciones

SCW serves as co-chair for the American College of Chest Physicians' chapter on the treatment of venous thromboembolic disease

Clinical Pharmacy Manager

Critical Care and Emergency Medicine

Advanced Clinical Pharmacist

Neuroscience Critical Care

Intermountain Medical Center

Murray

UT

Divulgaciones

GVF has received financial compensation for speaking engagements and clinical consultation from Portola Pharmaceuticals, the manufacturer of Andexxa, as well as Bevyxxa and Janssen, the manufacturer of Xarelto.

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

Divulgaciones

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 por paresVER TODOS

Associate Professor of Medicine

University of Alabama at Birmingham

Birmingham

AL

Divulgaciones

KW declares that he has no competing interests.

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

Divulgaciones

JRC declares that he has no competing interests.

Advanced Clinical Fellow

Cleveland Clinic Foundation

Cleveland

OH

Divulgaciones

SW declares that he has no competing interests.

Respiratory Physician and Associate Professor

Ramón y Cajal Hospital and Alcalá de Henares University

Respiratory Department and Medicine Department

Madrid

Spain

Divulgaciones

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

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