So what's the treatment for pulmonary embolus?
Well, somebody is hypoxic, you need to give
them oxygen, if they have fluid resuscitation
problems, if they're the hypotensive due to
the large PEs and then you need fluid replacement
and they might need inotropes as well.
Specific treatment for pulmonary emboli is anticoagulation
and acutely we use low molecular weight heparin
injections for that and then once the patient
has recovered from the initial pulmonary emboli,
then they go on to warfarin treatment to try
and prevent recurrence of the pulmonary emboli.
New oral anticoagulants, such as Rivaroxaban or apixaban,
are now the preferred agents of choice, but the selection of any agent
has to take into account patient bleeding risk, comorbidities, and costs.
Now the period of duration that they require
the warfarin therapy for is about 3 to 6 months,
if there's a known cause. So if somebody has
a PE after surgery, then you know that you
can you can give them anticoagulation for
3 to 6 months, and then stop it and the chance
of the PE recurring is limited. However, if they
have inherited deficiency of the coagulation,
where they've had multiple PEs in the past,
then in fact, they are probably gonna require
lifelong anticoagulation with warfarin or
similar oral anticoagulant.
Patients presenting with very large pulmonary
emboli causing hypotension and shock, those
are frequently treated with thrombolysis,
outer place treatment, to try and dissolve
the clot. And that has, that can rapidly correct
the cardiovascular problems occurring due
to large PEs. If somebody is presenting
with current pulmonary
emboli despite anticoagulation, then they
may have inferior vena cava filter fitted
to try and prevent the clots breaking out
from the DVTs and reaching the lungs.
Finally, some patients with acute pulmonary
emboli who are not ongoing major physiological
upset from that, where thrombolysis has not
worked or cannot be used for whatever reason,
they might need surgical removal of the clot,
but it's very, very rare that that is required.
Most patients can be treated with either anticoagulation
or for very large PEs, thrombolysis and anticoagulation.