Pathophysiology, Diagnosis and Treatment of Pulmonary Embolism Focusing on Thrombolysis - New approaches

1.1 Incidence and mortality of pulmonary embolism Pulmonary embolism (PE) is not a disease by itself but may have a venous thrombotic source and is therefore more precise if classified as venous thromboembolism (VTE). According to the international registry, the frequency of VTE is 150-200 new cases diagnosed per 100,000 inhabitants per year. Out of this, one third is diagnosed as primary PE (Oger, 2000; Walther et al., 2009). Following the diagnosis the average mortality is 11% in the first two months (Goldhaber et al., 1999). In the ICOPER study, the total mortality of PE in the first 3 months was 17.5%. However, in the long run the recurrent embolic episodes and lack of revascularisation caused progressive pulmonary hypertension (Goldhaber et al., 1999). The mortality of untreated PE is 30% and with adequate treatment can be reduced to 2-8% (Goldhaber, 1998). The hospital mortality of haemodynamically stable PE patients is overall 10% in general, 4% in the first 24 hours (Kline et al., 2003). Mortality of PE with respiratory and cardiovascular failure on hospital admission can be up to 95%. Hospital mortality is 80% in patients requiring mechanical ventilation and 77% in those who need cardiopulmonary resuscitation in the first 24 hours (Janata et al., 2002). Only 29% of fatal PE cases (verified at hospital autopsies) were previously diagnosed clinically. Based on these facts, the primary goal in PE management is a rapid and clear diagnosis followed by the appropriate treatment (S. Buchner & Th. Hachenberg, 2005).