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
Autores
Scott Stevens, MD
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.
Scott C. Woller, MD
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
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
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.
Agradecimientos
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 pares
Keith Wille, MD, MSPH
Associate Professor of Medicine
University of Alabama at Birmingham
Birmingham
AL
Divulgaciones
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
Divulgaciones
JRC declares that he has no competing interests.
Sanjeev Wasson, MD
Advanced Clinical Fellow
Cleveland Clinic Foundation
Cleveland
OH
Divulgaciones
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
Divulgaciones
DJ has received consulting fees from Boehringer Ingelheim, Bayer, Leo-Pharm, and Rovi, and lecture fees from Sanofi Aventis.
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