Blood Clots: Pulmonary Embolism Treatment

  • Treatment

    Pulmonary embolism is life-threatening and must be treated at once. If any of the following symptoms occur suddenly, seek medical attention immediately:

    • shortness of breath
    • sharp, stabbing chest pain, which may worsen with breathing
    • rapid heart rate
    • coughing up blood or blood-streaked sputum
    • dizziness or fainting.

    These symptoms can also indicate life-threatening conditions other than pulmonary embolism.

    Signs of deep venous thrombosis in the leg warrants immediate medical attention because of the danger that a pulmonary embolism can occur. If you think you may have a clot in your leg, call your doctor for an appointment the same day or go to an emergency room if your doctor is unavailable. Symptoms include marked swelling or pain in one leg, most often in the calf muscle area, and less frequently in the thighs. Discomfort usually increases with walking. Redness may not be apparent if affected veins are deep.

    If you are taking warfarin (Coumadin)--a medication used to prevent clots from forming or from getting larger—you should take precautionary measures with your diet and activities.

    • Food and supplements. If you are taking warfarin (Coumadin), you should avoid vitamin K-rich foods such as green leafy vegetables. You should also avoid dietary supplements that contain vitamin K, as well as painkillers such as aspirin or acetaminphen.
    • Activity. If you are taking warfarin, avoid activities that could cause injury and bleeding. For example, wear gloves when you’re working outside or around the house, shave with an electric razor, and don’t walk barefoot. In addition, don’t sit in one position for too long. Try to get up and walk around at least once every hour, and move your legs and feet around while you are sitting.
    • Monitoring. Patients taking warfarin must have regular blood tests, usually once a month, to monitor its effect.

    Your doctor is the best source of information on the drug treatment choices available to you.

    You will be given oxygen to help your body maintain normal concentrations.

    Clot-trapping filters can help in some circumstances. If you cannot take blood-thinning medications, a special fine-meshed screen that acts as a trap for thrombi can be inserted into the main vein (the vena cava) that leads from the legs to the heart. This device is like a screen tent that lodges permanently in a leg vein. It funnels clots to the tip of the tent, allowing blood to pass by, and keeping the clot from reaching the lungs. Once the clot is trapped, the body will naturally dissolve the clot through a process called lysis.

    For a very large embolism, a surgery known as pulmonary embolectomy can be performed to remove the blockage.

    Although women can safely breastfeed while taking warfarin (Coumadin), they should generally not take the drug in the first trimester of pregnancy. Pregnant women can take heparin. If you require coumadin and you are considering pregnancy, talk to your doctor first.

    Pulmonary embolism can be fatal if it is not detected and treated quickly. Fortunately, treatment is life-saving in almost all cases. If not treated promptly, people with life-threatening pulmonary embolism have a death rate of 30%. With rapid diagnosis and treatment, this rate drops to 3%.

    Although most people recover completely after a pulmonary embolism, some lung damage may remain. About 10% of patients are left with permanent damage to part of their lung. Remaining damage is especially likely if lung disease was present before the embolism. Lung damage may result in shortness of breath that occurs more often than before, possibly requiring oxygen supplementation.

    Once you have had a pulmonary embolism, you have an increased risk of having another. If you are predisposed to blood clots, you may need to take warfarin for the rest of your life to minimize the risk for having an embolism.

    People on warfarin must have their blood tested regularly. Warfarin can be dangerous: a dose that is too high increases your risk for bleeding and stroke. Careful monitoring is required to ensure that the levels of the drug are not too high. However, the medication's activity in the blood is not simply dose-related—it also varies with diet, other medications, illness, activity levels, and even prolonged hot weather. To monitor the medication, you will need a type of blood test called a prothrombin time (“pro-time” or PT test), which provides an indication of blood clotting activity. If the prothrombin time is too low—indicating that clots will occur faster—a higher dose is needed. If the prothrombin time is too high—indicating that clots will take longer to form—a shot of vitamin K is given to boost the body's manufacture of clotting factors. To find the right level, prothrombin time must be checked every week when you first start therapy, and it will be checked once a month throughout therapy.

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