Pulmonary Embolism: Treatment Options

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A pulmonary embolism (PE) occurs when a blood clot (embolus) enters a pulmonary artery (blood vessel) in the lungs and blocks normal blood flow. In most cases, the blood clot originates in a deep vein in the leg (known as deep vein thrombosis) and breaks free, traveling through the bloodstream and to the lungs. 

When a pulmonary embolism blocks blood flow to the lungs, your body’s oxygen level can drop to dangerously low levels. Without prompt treatment, PE can cause organ damage or death. Treatment may involve blood thinning or clot-busting medications depending on the severity and size of the PE. If medications are ineffective, surgery may be necessary to remove life-threatening clots.

Most people with PE require hospitalization and will receive initial treatments in the intensive care unit. A team of healthcare providers—including pulmonologists (doctors who specialize in diseases affecting the lungs), vascular surgeons (doctors who specialize in treating blood vessel conditions), and hematologists (doctors who specialize in treating blood disorders)—treat people with pulmonary embolism.

Most people with PE will receive initial treatments in the hospital until the clot clears. Your healthcare team will work together to assess your condition, determine the most appropriate treatment plan, and monitor your recovery.

Medications are the first-line treatments for a pulmonary embolism. Depending on your symptoms and the size of your blood clot, healthcare providers may use blood thinners, clot-busting medications, or both.

Anticoagulants

Anticoagulant therapy is the primary treatment for a pulmonary embolism. Anticoagulant drugs (blood thinners) prevent the blood clot from getting bigger and stop new clots from forming. These medications do not dissolve the clot but prevent it from getting bigger, while your body dissolves the clot over time.

You will receive anticoagulant drugs, such as Heparin (Heparin) or Lovenox (enoxaparin), in the hospital through intravenous (IV) infusion or injection. Once you leave the hospital, you will take oral blood thinners by mouth for at least three months. Some people take blood thinners indefinitely to prevent new clots from forming. Common oral blood thinner pills include Coumadin (warfarin), Jantoven (warfarin), Xarelto (rivaroxaban), and Pradaxa (dabigatran).

Thrombolytics 

Clot-busting medications, known as thrombolytics, help break up and dissolve large blood clots. These medications work by activating enzymes that break down fibrins (proteins) that form blood clots. Thrombolytics are given intravenously for people with severe blood clot symptoms and a high risk of complications. They work quickly to restore normal blood flow to the lungs. The most common clot-busting drugs include Activase (alteplase), Streptase (streptokinase), and Kinlytic (urokinase).

Surgery and other specialist procedures are sometimes necessary when medication is ineffective or for people with large, life-threatening blood clots. These procedures mechanically remove or dissolve the clot or use catheters to deliver clot-busting medications directly to the blood clot. 

Catheter-Directed Embolectomy

Catheter-directed embolectomy, or thrombolectomy, uses a thin, flexible tube (catheter) to reach the affected pulmonary artery and dissolve or break up the blood clot. During this procedure, your healthcare provider will make a small cut in your groin or neck and guide the catheter to the blood clot. Your provider can also insert a tool in the tube to manually break up the blood clot, suction it, or deliver clot-busting medications directly.

Surgical Embolectomy 

This procedure is usually only performed in life-threatening scenarios, when a massive PE causes serious symptoms, such as dangerously low blood pressure or septic shock. It is an invasive procedure that comes with the same risks as open-heart surgery. During the surgery, a surgeon makes an incision (cut) in the chest to access the affected pulmonary artery. The surgeon then carefully removes the clot from the artery using specialized surgical tools.

Vena Cava Filter 

A vena cava filter (IVC filter) is a small, metal device placed in the inferior vena cava—the large vein in the abdomen that carries blood from the lower body to the heart. The filter traps blood clots that travel from the lower body and prevents them from reaching the lungs, where they can cause a pulmonary embolism (PE). People who are not good candidates for blood thinners (anticoagulants) may get an IVC to prevent future PE.

Pulmonary embolism can be life-threatening. Unfortunately, about 12% of people die from PE. With prompt diagnosis and treatment, most people with pulmonary embolism recover. People who have had a PE are at an increased risk of having another PE in the future. Generally, about one-third of all cases will have a recurrence (another PE) within ten years.

Adhering to your treatment plan and taking your medications as prescribed, such as anticoagulants, is the best way to prevent recurrent PE. Practicing healthy lifestyle choices, like eating a heart-healthy diet, exercising regularly, and quitting smoking, can also reduce the risk or prevent blood clots from occurring. 

Pulmonary embolism (PE) is a serious, potentially life-threatening condition that occurs when a blood clot blocks a major artery in your lungs. Anticoagulant (blood-thinning) medications are the first-line treatment for PE. Clot-busting medications and specialist procedures may be necessary for large PE or for clots causing severe symptoms. With prompt medical attention and treatment, most people experiencing PE recover. The risk of recurrence is high, but following your treatment plan and making healthy lifestyle choices can help prevent future blood clots in the lungs.

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