How Is Pulmonary Embolism Treated?
Goals of Treatment
The main goals of treating pulmonary embolism (PE)
are to:
- Stop the blood clot from getting bigger
- Keep new clots from forming
Treatment may include medicines to thin the blood
and slow its ability to clot. If your symptoms are life threatening, the doctor
may give you medicine to dissolve the clot more quickly. Rarely, the doctor may
use surgery or another procedure to remove the clot.
Specific Types of Treatment
Medicines
Anticoagulants (AN-te-ko-AG-u-lants), which are
blood-thinning medicines, decrease your blood's ability to clot. They're used
to stop blood clots from getting bigger and to prevent clots from forming. They
don't break up blood clots that have already formed. (The body dissolves most
clots with time.)
Anticoagulants can be taken as either a pill, an
injection, or through a needle or tube inserted into a vein (called
intravenous, or IV, injection). Warfarin is given in a pill form.
(Coumadin® is a common brand name for warfarin.) Heparin is
given as an injection or through an IV tube.
Your doctor may treat you with both heparin and
warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days
before it starts to work. Once warfarin starts to work, usually the heparin
will be stopped.
Pregnant women usually are treated with heparin
only, because warfarin is dangerous for the pregnancy.
If you have
deep
vein thrombosis, treatment with anticoagulants usually lasts for 3 to 6
months.
If you have had blood clots before, you may need a
longer period of treatment. If you're being treated for another illness, such
as cancer, you may need to take anticoagulants as long as risk factors for PE
are present.
The most common side effect of anticoagulants is
bleeding. This happens if the medicine thins your blood too much. This side
effect can be life threatening. Sometimes, the bleeding can be internal. This
is why people treated with anticoagulants usually receive regular blood tests.
These tests are called PT and PTT tests, and they measure the blood's ability
to clot. These tests also help the doctor make sure you're taking the right
amount of medicine. Call your doctor right away if you have easy bruising or
bleeding.
Thrombin inhibitors are a newer type of
anticoagulant medicine. They're used to treat some types of blood clots for
patients who can't take heparin.
Emergency Treatment
When PE is life threatening, doctors may use
treatments that remove or break up clots in the blood vessels of the lungs.
These treatments are given in the emergency room or in the hospital.
Thrombolytics are medicines given to quickly
dissolve a blood clot. They're used to treat large clots that cause severe
symptoms. Because thrombolytics can cause sudden bleeding, they're used only in
life-threatening situations.
In some cases, the doctor may use a catheter to
reach the blood clot. A catheter is a flexible tube placed in a vein to allow
easy access to the bloodstream for medical treatment. The catheter is inserted
into the groin (upper thigh) or arm and threaded through a vein to the clot in
the lung. The catheter may be used to extract the clot or deliver medicine to
dissolve it.
Rarely, surgery may be needed to remove the blood
clot.
Other Types of Treatment
When you can't take medicines to thin your blood, or
when you're taking blood thinners but continue to develop clots anyway, the
doctor may use a device called a vena cava filter to keep clots from traveling
to your lungs. 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). The
filter catches clots before they travel to the lungs. This prevents PE, but it
doesn't stop other blood clots from forming.
Graduated compression stockings can reduce the
chronic (ongoing) swelling that may occur after a blood clot has developed in a
leg. The leg swelling is due to damage to the valves in the leg veins.
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 ankle and
become looser as they go up the leg. This causes a gentle compression (or
pressure) up the leg. The pressure keeps blood from pooling and clotting.
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