Resumen
Definición
Anamnesis y exploración física
Factores clave de diagnóstico
- presencia de factores de riesgo
- dolor torácico
- disnea
- taquipnea
- presíncope o síncope
- hipotensión (presión arterial sistólica <90 mmHg)
Otros factores para el 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
- mayor edad
- diagnóstico de trombosis venosa profunda (TVP)
- obesidad (índice de masa corporal [IMC] ≥29 kg/kg/m²)
- cirugía en los últimos 2 meses
- reposo en cama >5 días
- evento tromboembólico venoso previo
- antecedentes familiares de tromboembolia venosa (TEV)
- neoplasia maligna activa
- tabaquismo
- enfermedad pulmonar obstructiva crónica (EPOC)
- traumatismo o fractura recientes
- insuficiencia cardíaca congestiva (ICC)
- cateterismo venoso central
- embarazo/período posnatal
- venas varicosas
- viajes recientes en avión
- antecedentes de aborto espontáneo
- infarto agudo de miocardio reciente
- sepsis
- transfusión de sangre reciente
- anticoncepción hormonal combinada
- tratamiento hormonal sustitutivo (THS) oral
- parálisis de las extremidades inferiores
- enfermedad inflamatoria intestinal
- síndrome nefrótico
- enfermedad de Behcet
- homocisteinemia
- Neoplasias mieloproliferativas Filadelfia negativas
- mutación del factor V de Leiden
- mutación del gen G20210A de la protrombina
- deficiencia de antitrombina
- deficiencia de proteína C
- deficiencia de proteína S
- síndrome de anticuerpos antifosfolípidos
Pruebas diagnósticas
Primeras pruebas que 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
- hemograma completo (HC)
- Criterios para descartar embolismo pulmonar (PERC)
- Prueba del dímero D
Pruebas que considerar
- radiografía de tórax (RT)
- angiografía por resonancia magnética (RM)
- angiografía pulmonar
- electrocardiograma (ECG)
- gasometría arterial (GSA)
- cribado de trombofilia
- ecografía
Pruebas emergentes
- péptido natriurético cerebral (BNP), prohormona N-terminal del péptido natriurético cerebral (NT-proBNP) y proteína transportadora de ácidos grasos específica del miocardio (H-FABP)
Algoritmo de tratamiento
Colaboradores
Autores
Director
Thrombosis Clinic
Intermountain Medical Center
Murray
UT
Professor of Medicine
Department of Internal Medicine
University of Utah
Salt Lake City
UT
Conflicto de intereses
SMS is an investigator for two investigator-initiated clinical trials for which his institution receives funds from Bristol-Myers Squibb to enrol patients.
Director
Thrombosis Clinic
Intermountain Medical Center
Murray
UT
Professor of Medicine
University of Utah
Salt Lake City
UT
Conflicto de intereses
SCW holds two investigator-initiated grants from Bristol-Myers Squibb/Pfizer paid to his employer Intermountain Healthcare for which he receives no compensation. He has been invited to serve as co-chair of the American College of Chest Physicians guideline on antithrombotic therapy for venous thromboembolic disease (AT11) and serves as an invited panelist for the US Centers for Disease Control and Prevention venous thromboembolism risk assessment model systematic review and guidance panel.
Clinical Coordinator
Critical Care Pharmacy
Advanced Clinical Pharmacist
Neuroscience Critical Care
Intermountain Medical Center
Murray
UT
Conflicto de intereses
GVF receives consulting fees and honoraria from Portola Pharmaceuticals for clinical consulting and speaking engagements.
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.
Conflicto de intereses
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 pares
Associate Professor of Medicine
University of Alabama at Birmingham
Birmingham
AL
Conflicto de intereses
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
Conflicto de intereses
JRC declares that he has no competing interests.
Advanced Clinical Fellow
Cleveland Clinic Foundation
Cleveland
OH
Conflicto de intereses
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
Conflicto de intereses
DJ has received consulting fees from Boehringer Ingelheim, Bayer, Leo-Pharm, and Rovi, and lecture fees from Sanofi Aventis.
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