How is pulmonary embolism treated?

How is pulmonary embolism treated?

Pulmonary embolism is blocks in blood vessels of the lungs due to clots migrating from other parts of the body. It is a potentially life threatening condition if large blood vessels of the lungs or multiple blood vessels are blocked. More clots can travel to the lungs from the original source and hence pulmonary embolism may worsen later even if the initial block involves only a small portion of the lungs. So it is important to treat pulmonary embolism even if it is mild. Treatment options will depend on the severity of the situation.

Initial treatment will be medications known as anticoagulants which prevent the formation of blood clots. Often an injectable form known as heparin or low molecular weight heparin is started first and when the condition is stable, long term treatment is with oral medications. There is also another injectable medication known as fondaparinux which can be used in the initial treatment of pulmonary embolism. As these medications increase the chance of bleeding, close medical supervision is needed, often with regular blood tests of clotting function.

Oral medications belong to two important groups. The time old one is warfarin, which is a vitamin K antagonist. Newer medications are known as non-vitamin K antagonists or NOACs in short. Warfarin needs regular monitoring of clotting function with a test known as PT-INR or prothrombin time with international normalized ratio estimation. NOACs being newer drugs, are costlier but do not need PT-INR monitoring. Bleeding risk is there for both groups of medications and need close medical supervision.

Those with more severe forms of pulmonary embolism with fall in blood pressure may need a group of medications which dissolve blood clots. They are called clot busters or thrombolytic agents. These have even more risk of causing bleeding elsewhere and are usually given only in the intensive care setting with close medical supervision. They cannot be given for those who have certain other medical conditions which make bleeding risk higher.

Another option in case of life threatening situations not responding to medical treatment is surgery to remove the blood clots from the blood vessels of the lungs. Sometimes tubes may be introduced into the blood vessels of the lungs through blood vessels of the groin to fragment and suck out the clots. In patients with recurrent pulmonary embolism, a filter may be deployed in the large vein of the tummy, known as inferior vena caval filter. This will trap the clots migrating from the legs to lungs midway.

In case of pulmonary embolism, prevention is equally important, both for first episode and for recurrent episodes. This has been dealt with in an earlier article: Simple ways to prevent clots in legs and pulmonary embolism.