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Pulmonary embolus - Treatment

Alternative Names

Venous thromboembolism; Lung blood clot; Blood clot - lung; Embolus; Tumor embolus

Treatment:

Emergency treatment and a hospital stay are often necessary. The aim is to prevent new clots from forming. Oxygen therapy may be required to maintain normal oxygen levels.

In cases of severe, life-threatening pulmonary embolism, treatment may involve dissolving the clot and preventing new clots from forming.

Treatment to dissolve clots is called thrombolytic therapy. Clot-dissolving medications include:

Streptokinase
t-PA

Treatment to prevent clots is called anticoagulation therapy. Such drugs are commonly called blood thinners. Clot-prevention medicines include heparin and warfarin (Coumadin). Heparin or heparin-type drugs can be given intravenously (by IV, directly into a vein), or as injections under the skin. These are usually the first medications given, and are then transitioned over to warfarin given in pill form.

When you first start taking warfarin you will need frequent lab tests to check the thickness of your blood. This will help your doctor properly adjust your dose.

Patients who have reactions to heparin or related medications may need other medications.

Patients who cannot tolerate blood thinners may need a device called an inferior vena cava filter (IVC filter). This device is placed in the main central vein in the belly area. It keeps large clots from traveling into the blood vessels of the lungs. Sometimes a temporary filter can be placed and removed later.

Expectations (prognosis):

It is difficult to predict how well a patient will do. Often, the outlook is related to what put the person at risk for pulmonary embolism (for example, cancer, major surgery, trauma). In cases of severe pulmonary embolism, where shock and heart failure occur, the death rate may be greater than 50%.

Complications:

Heart failure or shock
Heart palpitations
Pulmonary hypertension
Severe breathing difficulty
Severe bleeding (usually a complication of treatment)
Sudden death

Calling your health care provider:

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of pulmonary embolus.

Lungs

Respiratory system

Pulmonary embolus

Reviewed last on: 1/27/2009
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Anderson DR, Kahn SR, Rodger MA, et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial.JAMA. 2007;298(23):2743-53.

Righini M, Le Gal G, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008;371(9621):1343-52.

Snow V, Qaseem A, Barry P, et al. Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2007;146(3):204-10. Epub 2007 Jan 29.

Tapson VF. Pulmonary embolism. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 99.

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