Treatment of Pulmonary Embolism

“Most patients do not know they are having a pulmonary embolism, only that they started feeling ‘funny’ typically with symptoms like sudden shortness of breath or chest pain,” said Kiran Reddy, MD, Catholic Health Cardiologist. “These symptoms are often mistaken for a heart attack, which makes it challenging to diagnose PE.”

He explained that seeking immediate medical treatment is the difference between life and death when someone experiences a pulmonary embolism.

“Through blood tests and imaging, we can confirm a PE diagnosis and start critical medical intervention,” he said. “PEs can be successfully treated if caught early.”

What is a pulmonary embolism? 

A pulmonary embolism (PE) is when a blockage occurs in the pulmonary arteries, which are the blood vessels that send blood to the lungs. Typically, one or more blood clots that start in a deep vein in the leg (deep vein thrombosis/DVT) and travel to the lungs cause this blockage.

Slowed blood flow to the lungs lowers critical oxygen the body needs and also causes the heart to work harder, which can lead to pulmonary hypertension. 

PEs can come on suddenly, within minutes or seconds, with symptoms like shortness of breath or chest pain. Others experience pulmonary embolism symptoms over days or weeks. 

How is a pulmonary embolism treated?

A PE is considered a life-threatening medical emergency that requires prompt treatment to remove the clots and return to normal blood flow. The goal of treatment is to dissolve the blood clot, prevent new clots from forming, and minimize damage to lung tissue.  

Treatment will vary by person depending on how many clots, the severity of the clot, the location of the clot and a patient’s health, especially if they have preexisting heart or lung conditions. 

Medications

The most common pulmonary embolism medication dissolves clots and prevents new clots from forming.

Blood thinners (anticoagulants) are the first line of treatment for pulmonary embolisms to prevent new clots from forming and help shrink existing clots. Common blood thinners include heparin and warfarin. Your doctor will determine the best medicine for you and require routine blood tests to monitor and measure how fast the blood is clotting when on blood thinners.

Clot busters (thrombolytic or fibrinolytic therapy) are more powerful medications that dissolve clots. They are typically given intravenously (IV) for significant or life-threatening PEs. 

Catheter-Based Procedures

Some patients may need minimally invasive procedures to treat their pulmonary embolism.

Catheter-directed thrombolysis delivers clot-busting medication directly to the clot. Mechanical thrombectomy uses a catheter to remove the clot. 

Catholic Health's St. Francis Heart Center offers the Inari Medical FlowTriever, performed in a cardiac catheterization lab by our nationally recognized interventional cardiologists, to safely and effectively remove large clots from the pulmonary arteries without needing thrombolytic drugs. We also offer EKOS, a minimally invasive catheter-based procedure that uses ultrasound and medications to dissolve blood clots.

“These advanced catheter-based procedures help treat patients quickly and effectively,” said Dr. Reddy.  “As a minimally invasive procedure, recovery time is shorter, and a return to normal activities is possible once your doctor approves.”

What is the long-term management of pulmonary embolisms?

Routine follow-up care is critical while recovering from a pulmonary embolism. Nearly 33% of people affected by a deep vein thrombosis or pulmonary embolism will experience another PE within 10 years. 

“Your doctor will monitor your medications and ensure you are taking them correctly,” said Dr. Reddy. “They will also review other factors that put you at risk for developing a PE and the steps you can take to help prevent one from occurring.”

What are the risk factors for a pulmonary embolism?

Nearly 900,000 people in the United States experience a pulmonary embolism annually. The factors that can cause blood clots that lead to a pulmonary embolism differ by person. 

Common risk factors for a pulmonary embolism include:

• Personal history of a pulmonary embolism.
• Having blood relatives (such as parents or siblings) who were diagnosed with a venous blood clot or a pulmonary embolism.
• Heart conditions, including heart failure and atrial fibrillation (AFib), increase the likelihood of blood clots.
• Other medical conditions, including cancer, diabetes, lung disease, kidney disease and COVID-19, can increase the risk of blood clots.
• Blood clots are one of the most significant risks of major surgery. A doctor can prescribe medications before and after a surgical procedure to prevent clots.
• Prolonged periods of inactivity can lead to blood clots. Inactivity includes bed rest due to post-surgical recovery or recovery from a severe illness or injury like a heart attack or leg fracture that slows the flow of blood to the veins and can cause blood to pool in the legs. It also includes long trips that require sitting in a tight space for an extended duration, such as in a plane or car, which reduces blood flow to the legs. 
• Smoking and being overweight, especially with co-existing risk factors like diabetes or high blood pressure (hypertension), increase the risk of blood clots.
• For pregnant women, a baby’s weight can press on veins in the pelvis and reduce blood flow from the legs, leading to clots.

“Although there is no guarantee against a person developing blood clots that lead to a pulmonary embolism, we do know that identifying a patient’s risk factors and taking certain preventive steps can help,” said Dr. Reddy.

Are pulmonary embolisms preventable?

Tips to help prevent pulmonary embolisms include:

• Wear compression stockings, take standing breaks, and drink plenty of fluids when traveling. 
• Use a pneumatic compression device. The machine pumps air into cuffs on the lower legs that keep blood circulating.
• Elevate feet frequently, preferably every 30 minutes.
• Eat a well-balanced diet and maintain a healthy weight.
• Stay active and exercise regularly.
• Do not smoke.
• Maintain regular doctor appointments if you have a family or personal history of pulmonary embolisms. Or you have been diagnosed with deep vein thrombosis/DVT or conditions that increase the risk for blood clots.
• Talk to your doctor before any surgical procedure about the risk of clots.