Pulmonary embolism medical therapy
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Pulmonary Embolism Microchapters |
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Diagnosis |
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Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores |
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Treatment |
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Follow-Up |
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Special Scenario |
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Trials |
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Case Studies |
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Pulmonary embolism medical therapy On the Web |
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Directions to Hospitals Treating Pulmonary embolism medical therapy |
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Risk calculators and risk factors for Pulmonary embolism medical therapy |
Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
In most cases, anticoagulant therapy is the mainstay of treatment. For details, visit treatment approach. This chapter discusses the recommended doses.
Treatment Protocol[1]
Stabilize the patient
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Initial Treatment options (≤5 Days)
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| Long term treatment (≥3 Month) (INR target, 2.0-3.0) | |||||||||||||||||||
| Extended treatment (Indefinite) (INR target, 2.0-3.0 OR 1.5-1.9) | |||||||||||||||||||
Heparin
Subcutaneous Low molecular weight heparin, fondapariux or or Intravenous heparin is indicated in hemodynamically stable patients.
Dosages
Following doses are recommended[2]:
- Low molecular weight heparin
- Enoxaparin : 1 mg/Kg body weight (twice daily).
- Tinzaparin : 175 U/Kg body weight (once daily).
- Factor Xa Inhibitors/Fondaparinux
- Patient weighing less than 50 Kg (110 lb) : 5 mg (once daily).
- Patient weighing 50 Kg (110 lb) to 110 Kg (220 lb): 7.5 mg (once daily).
- Patient weighing more than 100 Kg (220 lb) : 10 mg (once daily).
- Unfractionated heparin
- Loading Dose: 80 IU/Kg or 5000 IU
- Mantainace Dose: 18 IU/Kg/Hr to achieve a target aPTT 1.5 to 2.5 times the normal value.
Warfarin
- The recommended therapeutic INR on warfarin is 2.0-3.0.
References
- ↑ Agnelli G, Becattini C (2010). "Acute pulmonary embolism". N Engl J Med. 363 (3): 266–74. doi:10.1056/NEJMra0907731. PMID 20592294.
- ↑ Raschke RA, Gollihare B, Peirce JC (1996). "The effectiveness of implementing the weight-based heparin nomogram as a practice guideline". Arch Intern Med. 156 (15): 1645–9. PMID 8694662.