Tromboembolia pulmonar. Conductas terapéuticas perioperatorias

Tamariz-Cruz, Orlando; Salguero-Ruiz, Christian
January 2009
Revista Mexicana de Anestesiologia;jan-mar2009, Vol. 32 Issue 1, p56
Academic Journal
Pulmonary thromboembolism (PTE) in the perioperative field is --besides being devastating-- a real therapeutic challenge, since the circumstances surrounding this pathology are very serious. In several occasions, we face the impossibility of performing a thrombolisis, due to an immediate postoperative state, or we have to take the patient to urgency surgery since he/she has developed pulmonary thromboemboli. This last fact complicates and reduces the therapeutic spectrum and it is associated to high perioperative mortality. This paper reviews the both the diagnostic approach of patients suffering from thromboembolism and the management strategies based upon evidence, with regard to effectiveness. It is described the most commonly employed medicines, such as heparins of low molecular weight, thrombolitics (streptokinase, alteplase), the hemodynamic management of the patients with (secondary) cardiogenic shock and the interventions, both surgical and percutaneous (embolectomy or catheter embolectomy). Finally, it is proposed a management and diagnosis algorithm for the surgical patient.


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