How is pulmonary embolism treated?

Treatment for pulmonary embolism is typically provided in a hospital, where your condition can be closely monitored.

The length of your treatment and hospital stay will vary, depending on the severity of the clot.

Depending on your medical condition, treatment options may include anticoagulant (blood-thinner) medications, thrombolytic therapy, compression stockings, and sometimes surgery or interventional procedures to improve blood flow and reduce the risk of future blood clots.

Anticoagulant medications

In most cases, treatment consists of anti- coagulant medications (also called blood thinners). Anticoagulants decrease the blood’s ability to clot and prevent future blood clots.

Anticoagulant medications include warfarin (Coumadin®), heparin, low-molecular weight heparin (such as Lovenox® or Dalteparin®) and fondaparinux (Arixtra®).

  • Warfarin comes in tablet form and is taken orally (by mouth).
  • Heparin is a liquid medication and is given either through an intravenous (IV) line that delivers medication directly into the vein, or by subcutaneous (under the skin) injections given in the hospital.
  • Low molecular-weight heparin is injected beneath or under the skin (subcutaneously). It is given once or twice a day and can be taken at home.
  • Fondaparinux (Arixtra) is a new medication that is injected subcutaneously, once a day.

You and your family will receive more information about how to take the anticoagulant medication that is prescribed. As with any medication, it’s important that you understand how and when to take your anticoagulant and to follow your doctor’s guidelines.

The type of medication you were prescribed, how long you need to take it, and the type of follow-up monitoring you’ll need depends on your diagnosis. Be sure to keep all scheduled follow-up appointments with your doctor and the laboratory so your response to the medication can be monitored closely.

While taking anticoagulants, your follow-up will include frequent blood tests, such as:

  • PT-INR: The Prothrombin time (PT or protime)/ International Normalized Ratio (INR) test: Your INR will help your health care provider determine how fast your blood is clotting and whether your medication dose needs to be changed. This test is used to monitor your condition if you are taking Coumadin.
  • Activated partial thromboplastin (aPTT): Measures the time it takes blood to clot. This test is used to monitor your condition if you are taking heparin.
  • Anti-Xa or Heparin assay: Measures the level of low molecular-weight heparin in the blood. It is usually not necessary to use this test unless you are overweight, have kidney disease or are pregnant.

What are other treatment options?

Compression stockings

Compression stockings (support hose) aid blood flow in the legs and should be used as prescribed by your doctor. The stockings are usually knee- high length and compress your legs to prevent the pooling of blood.

Talk with your doctor about how to use your compression stockings, for how long, and how to care for them. It is important to launder compression stockings according to directions to prevent damaging them.

Procedures

If a pulmonary embolism is life-threatening, or if other treatments aren’t effective, your doctor may recommend:

  • Surgery to remove the embolus from the pulmonary artery.
  • An interventional procedure in which a filter is placed inside the body’s largest vein (vena cava filter) so clots can be trapped before they enter the lungs.

Thrombolytic therapy

Thrombolytic medications (“clot busters”), including tissue plasminogen activator (TPA), are used to dissolve the clot. Thrombolytics are always given in a hospital where the patient can be closely monitored. These medications are used in special situations, such as if the patient’s blood pressure is low or if the patient’s condition is unstable due to the pulmonary embolism.

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