4.10
Embolia pulmonar I: Introducción
Un coágulo sanguíneo, o trombo, es una masa semisólida compuesta por fibrina, plaquetas y glóbulos rojos. Cuando se forma dentro de un vaso, puede obs…
Un coágulo sanguíneo, o trombo, se forma dentro de los vasos sanguíneos y puede bloquear el flujo sanguíneo parcial o totalmente. Esta condición se conoce como trombosis.
Si parte del coágulo se despega y viaja por el torrente sanguíneo, se convierte en un émbolo.
Si el émbolo se aloja en una arteria pulmonar, puede provocar una embolia pulmonar, o EP. En la mayoría de los casos, el émbolo se origina a partir de un trombo en las venas profundas de las piernas, una condición llamada trombosis venosa profunda.
El desarrollo de la EP se explica por la tríada de Virchow, que incluye estasis venosa, hipercoagulabilidad y lesión endotelial, tres factores que contribuyen a la formación de trombos.
La estasis venosa puede deberse a una inmovilidad prolongada, como tras una cirugía ortopédica o largos periodos sentados, como en vuelos prolongados en avión.
La hipercoagulabilidad puede deberse a condiciones como la deficiencia de antitrombina III, el embarazo o el uso de anticonceptivos que contienen estrógenos.
La lesión endotelial puede estar causada por un traumatismo o cateterismo venoso central.
View the full transcript and gain access to JoVE Core videos
Q1: What is the difference between a thrombus and an embolus?
A thrombus is a blood clot that forms within blood vessels and can block blood flow, a condition called thrombosis. An embolus forms when part of the thrombus breaks away and travels through the bloodstream. If the embolus lodges in a pulmonary artery, it causes a pulmonary embolism.
Q2: What is deep vein thrombosis and how does it relate to pulmonary embolism?
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins of the legs. In most cases, the embolus that causes pulmonary embolism originates from a thrombus in these deep leg veins. DVT and PE together are considered part of the same disease process called venous thromboembolism.
Q3: What are the three factors in Virchow's triad that contribute to blood clot formation?
Virchow's triad includes venous stasis, hypercoagulability, and endothelial injury. Venous stasis occurs when blood flow slows due to immobility from surgery or prolonged sitting. Hypercoagulability results from conditions like antithrombin III deficiency or pregnancy. Endothelial injury may be caused by trauma or catheterization.
Q4: What causes venous stasis and who is at risk?
Venous stasis occurs when blood flow becomes stagnant due to immobility. Risk factors include prolonged bed rest after orthopedic surgery, extended plane flights, heart failure, obesity, pregnancy, and catheter use. Any condition limiting movement can slow blood circulation in the veins.
Q5: What conditions increase blood coagulability and raise pulmonary embolism risk?
Hypercoagulability can be inherited, such as factor V Leiden or protein C/S deficiency, or acquired through malignancy, oral contraceptives, pregnancy, or inflammatory disorders. These conditions increase the tendency of blood to clot, raising the risk of thrombus formation and subsequent pulmonary embolism.
Q6: How can endothelial injury contribute to pulmonary embolism development?
Endothelial injury damages the inner lining of blood vessels, activating clotting pathways that promote thrombus formation. Trauma, surgery, or prior thrombosis can cause this vessel wall damage. When a resulting clot dislodges and travels to the lungs, it causes pulmonary embolism.
Q7: Why are hospitalized and cancer patients at higher risk for pulmonary embolism?
Hospitalized and cancer patients face increased risk due to immobility, inflammation, and procoagulant states that promote blood clotting. These factors align with Virchow's triad mechanisms: reduced blood flow, increased clotting tendency, and vessel damage. Understanding these mechanisms supports early detection and prevention strategies in chronic obstructive pulmonary disease clinical contexts.