Pulmonary embolism treatment approach

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]

Overview

Pulmonary embolism (PE) is a potentially lethal condition, with a mortality rate close to 30 percent without treatment. Thus prompt and effective therapy is utmost important. In most cases, anticoagulant therapy is the mainstay of treatment. Acutely, supportive treatments, such as oxygen or analgesia, are often required.

Treatment Algorithm

Stabilize the patient

Is anticoagulation contraindicated ?

Yes

No

Diagnostic evaluation

Anticoagulate with SC LMWH or IV UFH

PE excluded

PE confirmed

Diagnostic evaluation

No further Treatment

Inferior vena cava filter

PE excluded

PE confirmed

Discontinue Anticoagulants

Clinicaly severe enough to need Thrombolysis

Yes

No

Is thrombolytic Contraindicated?

Continue Anticoagulants

Yes

No

Surgical emblectomy or catheter based interventions

Hold Anticoagulation, Give Thrombolytics then resume Anticoagulations

Patient show Clinically Improvement

No

Yes

Surgical emblectomy or catheter based interventions

Continue Anticoagulation