Treatment

The primary goals in treating pulmonary embolism are to:

• Keep the blood clot or clots lodged in the lungs from getting bigger
• Stop the development of new clots

Treatment may include:

• Medicines
• Emergency treatment to dissolve a clot
• Other treatments

Treatment will vary depending on how severe your symptoms are. If your symptoms are severe, you need immediate emergency treatment. If your symptoms are mild, you can be treated as an outpatient.

Medicines

Anticoagulants (blood thinners) decrease your blood's ability to clot. They are used to stop clots from getting bigger and to prevent blood clots from forming. Anticoagulants do not break up blood clots that have already formed. Your body's natural system will dissolve the clot. Anticoagulants can be given:

• As a pill (warfarin)
• As an injection or shot (heparin)
• In a vein (intravenous or IV) (heparin)

Heparin and warfarin may be given at the same time. Heparin acts quickly, whereas warfarin takes 2 to 3 days before it starts to work. Once warfarin is working, the heparin will be stopped. Pregnant women cannot take warfarin and are treated with heparin only.

If you have deep vein thrombosis, treatment with anticoagulants usually lasts for 3 to 6 months. However, the length of treatment may vary if:

• Your blood clot occurred after a short-term risk, such as surgery. In this case, your treatment may be shorter.
• You have had clots before. You will need longer treatment.
• You are being treated for another illness (such as cancer). You will take anticoagulants for as long as those risk factors are present.

The most common side effect of anticoagulants is bleeding. You need to have regular blood tests to check how well the medicine is working. You should call your doctor right away if you have easy bruising or bleeding.

Thrombin inhibitors are new medicines that interfere with the clotting process. They are used to treat some types of clots for patients who cannot take heparin.

Emergency Treatment

When pulmonary embolism is life threatening, doctors may use treatments to remove or break up clots in the lungs. These treatments are given in the emergency room or in the hospital and include:

• Medicines called thrombolytics to quickly dissolve the blood clot. Thrombolytics are used to treat large clots causing severe symptoms.
• Surgery to remove the blood clot.
• A new procedure that uses a catheter to reach the clots. The catheter is inserted into the upper thigh (groin) or arm and threaded to the clot in the lung. The catheter may be used to extract the clot or deliver medicine to dissolve it.

Additional Considerations

Vena cava filters are used when you cannot take medicines to thin your blood, or if you are taking blood thinners and continue to develop clots. The filter is inserted inside a large vein called the inferior vena cava (the vein that carries blood from the body back to the heart). It can catch the clots as they try to move through the body to the lungs. This treatment can prevent a clot from traveling to the lungs. It cannot stop other clots from forming.

Graduated compression stockings are worn on the legs from the arch of the foot to just above or below the knee. These stockings are tight at the feet and become looser as they go up the leg. This causes a gentle compression (or pressure) up your leg. The stockings provide support and reduce the chronic swelling that can occur in the leg after a blood clot has occurred.

Reference:

National Heart, Lung, and Blood Institute, USA.