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Tromboembolismo Pulmonar Agudo: Uma Revisão Bibliográfica dos Avanços no Diagnóstico e no Tratamento
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Authors
Abstract(s)
Introdução: O tromboembolismo pulmonar agudo é uma condição clínica de elevada
morbimortalidade, caracterizada pela obstrução das artérias pulmonares por trombos. A
sua apresentação heterogénea e o impacto clínico significativo tornam-no um desafio na
prática clínica. Nas últimas décadas, os avanços no diagnóstico, na estratificação do risco e
nas opções terapêuticas têm transformado a gestão desta patologia. Esta revisão
bibliográfica visa consolidar os progressos mais recentes, identificar lacunas existentes e
explorar perspetivas futuras na abordagem ao tromboembolismo pulmonar agudo.
Materiais e métodos: Foi realizada uma pesquisa bibliográfica nas bases de dados PubMed,
Scopus e Web of Science. Foram incluídas revisões bibliográficas, revisões sistemáticas,
meta-análises e ensaios clínicos controlados e randomizados publicados entre 2014 e 2024,
em inglês e português. Adicionalmente, foi incluído o estudo PIOPED pela sua relevância
histórica. As palavras-chave utilizadas incluíram “pulmonary embolism”, “biomarkers”,
“catheter-directed therapy”, “risk stratification” e “direct oral anticoagulants”. Foram
excluídos artigos referentes a idades pediátricas.
Resultados: Os avanços no diagnóstico incluem tecnologias emergentes, como a tomografia
computadorizada por contagem de fotões e a tomografia computadorizada por emissão de
fotão único, bem como a integração de biomarcadores, como o BNP, troponina e o lactato,
em scores de risco, contribuindo para uma maior personalização da gestão do
tromboembolismo pulmonar. Algoritmos como o YEARS e o PEGeD mostram-se eficazes
na otimização dos níveis de corte dos D-dímeros, reduzindo exames desnecessários, custos
e exposição à radiação. No tratamento, os anticoagulantes orais diretos revolucionaram a
gestão do tromboembolismo pulmonar pela sua segurança e praticidade, enquanto as
intervenções por cateter e a trombólise de baixa dose emergem como alternativas
promissoras em casos mais complexos. As equipas multidisciplinares de resposta à embolia
pulmonar, em crescimento a nível global, permitiram obter melhores desfechos clínicos,
através de uma abordagem colaborativa e eficaz.
Conclusão: Os avanços no diagnóstico e no tratamento do tromboembolismo pulmonar
agudo têm proporcionado melhorias significativas na abordagem desta patologia. Contudo,
subsistem desafios importantes, como o desenvolvimento de ferramentas adicionais para a
estratificação do risco, a validação de novas tecnologias e a definição de critérios claros para
as terapêuticas emergentes. Esta revisão sublinha a necessidade de esforços contínuos para
superar as lacunas existentes, promovendo uma prática clínica baseada em evidências, que equilibre a inovação com a segurança, contribuindo para melhores desfechos clínicos e para
uma melhor qualidade de vida dos pacientes com tromboembolismo pulmonar agudo.
Introduction: Acute pulmonary embolism is a clinical condition with high morbidity and mortality, characterized by the obstruction of pulmonary arteries by thrombi. Its heterogeneous presentation and significant clinical impact make it a challenge in clinical practice. Over the past decades, advances in diagnosis, risk stratification, and therapeutic options have transformed the management of this condition. This literature review aims to consolidate the most recent progress, identify existing gaps, and explore future perspectives in the approach to acute pulmonary embolism. Materials and Methods: A bibliographic search was conducted in the PubMed, Scopus, and Web of Science databases. Reviews, systematic reviews, meta-analyses, and randomized controlled trials published between 2014 and 2024, in English or Portuguese, were included. Additionally, the PIOPED study was incorporated due to its historical relevance. The keywords used included "pulmonary embolism," "biomarkers," "catheterdirected therapy”, "risk stratification," and "direct oral anticoagulants." Articles related to the pediatric population were excluded. Results: Advances in diagnosis include emerging technologies such as photon-counting computed tomography and single-photon emission computed tomography, as well as the integration of biomarkers such as BNP, troponin, and lactate into risk scores, contributing to greater personalization in pulmonary embolism management. Algorithms such as YEARS and PEGeD have proven effective in optimizing D-dimer thresholds, reducing unnecessary imaging, costs, and radiation exposure. In treatment, direct oral anticoagulants have revolutionized pulmonary embolism management, while catheter-directed interventions and low-dose thrombolysis are emerging as promising alternatives for more complex cases. Multidisciplinary pulmonary embolism response teams have demonstrated improvements in clinical outcomes. Conclusion: Advances in the diagnosis and treatment of acute pulmonary embolism have significantly improved the management of this condition. However, important challenges remain, such as the development of additional tools for risk stratification, the validation of new technologies, and the establishment of clear criteria for emerging therapies. This review highlights the need for continuous efforts to address existing gaps, promoting evidencebased clinical practice that balances innovation with safety, ultimately contributing to better clinical outcomes and improved quality of life for pulmonary embolism patients.
Introduction: Acute pulmonary embolism is a clinical condition with high morbidity and mortality, characterized by the obstruction of pulmonary arteries by thrombi. Its heterogeneous presentation and significant clinical impact make it a challenge in clinical practice. Over the past decades, advances in diagnosis, risk stratification, and therapeutic options have transformed the management of this condition. This literature review aims to consolidate the most recent progress, identify existing gaps, and explore future perspectives in the approach to acute pulmonary embolism. Materials and Methods: A bibliographic search was conducted in the PubMed, Scopus, and Web of Science databases. Reviews, systematic reviews, meta-analyses, and randomized controlled trials published between 2014 and 2024, in English or Portuguese, were included. Additionally, the PIOPED study was incorporated due to its historical relevance. The keywords used included "pulmonary embolism," "biomarkers," "catheterdirected therapy”, "risk stratification," and "direct oral anticoagulants." Articles related to the pediatric population were excluded. Results: Advances in diagnosis include emerging technologies such as photon-counting computed tomography and single-photon emission computed tomography, as well as the integration of biomarkers such as BNP, troponin, and lactate into risk scores, contributing to greater personalization in pulmonary embolism management. Algorithms such as YEARS and PEGeD have proven effective in optimizing D-dimer thresholds, reducing unnecessary imaging, costs, and radiation exposure. In treatment, direct oral anticoagulants have revolutionized pulmonary embolism management, while catheter-directed interventions and low-dose thrombolysis are emerging as promising alternatives for more complex cases. Multidisciplinary pulmonary embolism response teams have demonstrated improvements in clinical outcomes. Conclusion: Advances in the diagnosis and treatment of acute pulmonary embolism have significantly improved the management of this condition. However, important challenges remain, such as the development of additional tools for risk stratification, the validation of new technologies, and the establishment of clear criteria for emerging therapies. This review highlights the need for continuous efforts to address existing gaps, promoting evidencebased clinical practice that balances innovation with safety, ultimately contributing to better clinical outcomes and improved quality of life for pulmonary embolism patients.
Description
Keywords
Anticoagulante Biomarcadores Embolia Pulmonar Estratificação do Risco Intervenções Dirigidas por Cateter