Treatment of PE

00:01 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.

00:15 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.

00:30 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.

00:44 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.

01:14 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.

01:51 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.

02:07 Most patients can be treated with either anticoagulation or for very large PEs, thrombolysis and anticoagulation.