[Acute pulmonary embolism: still a diagnostic and therapeutic challenge?]
BACKGROUND
Acute pulmonary embolism (PE) is a cardiovascular emergency with high mortality in which a rapid diagnosis and the early initiation of therapy is vital. In the present study patients with acute PE hospitalized at the Clinic Lippe in Detmold were characterized and their prognosis examined.


METHODS
In our department at the hospital Detmold, all patients with acute PE admitted in 2012 and 2013 were documented with respect to the severity of PE, predisposing risk factors and diagnostic and therapeutic steps.


RESULTS
A total of 170 patients with acute PE were documented of which 80 patients (47 %) had low, 70 patients an intermediate (41 %) and 20 a high risk (12 %). The main diagnostic tool was thoracic computed tomography (82 %). All patients initially received unfractionated or low-molecular weight heparin; systemic intravenous fibrinolysis was carried out in 3 % of patients (intermediate risk n = 1, high risk n = 4). Nineteen percent (n = 13) of the patients at intermediate and 30 % (n = 6) of patients at high risk received local intrapulmonary fibrinolysis. Overall, the mortality rate in hospital was 10 % (low risk 2.5 %; intermediate risk 7 %; high risk 58 %). All 5 patients who received systemic emergency lysis died. One (5.3 %) of the 19 patients at intermediate risk, undergoing local intrapulmonary fibrinolysis, died.


CONCLUSIONS
In acute PE a rapid diagnosis and the initiation of an adequate therapy remains a big challenge. Further studies are required to evaluate if aggressive treatment options might reduce mortality especially among patients at intermediate or high risk.
Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland.
R
R
Felgendreher
Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland.
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D
Härtel
Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland.
J
J
Brockmeier
Institut für Pharmakologie und Präventive Medizin, Mahlow, Deutschland.
K
K
Bramlage
Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland.
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Aschenbrenner
Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland.
J
J
Götz
Institut für Pharmakologie und Präventive Medizin, Mahlow, Deutschland.
P
P
Bramlage
Klinik für Innere Medizin/Kardiologie, Angiologie und Internistische Intensivmedizin, Herz-Kreislauf-Zentrum, Klinikum Lippe GmbH, Röntgenstr. 18, 23756, Detmold, Deutschland. u.tebbe@onlinehome.de.
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U
Tebbe
D006801:Humans; D011379:Prognosis; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy; D012307:Risk Factors; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed
Acute; Lysis; Mortality; Prognosis; Pulmonary embolism