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.