Treatment:

Emergency treatment and hospitalization may be necessary. In cases of severe, life-threatening pulmonary embolism, definitive treatment may consist of dissolving the clot with thrombolytic therapy. Anticoagulant therapy prevents the formation of more clots and allows the body to re-absorb the existing clots faster.

Clot-dissolving medication (thrombolytic therapy) includes streptokinase, urokinase, or t-PA. Clot-preventing medication (anticoagulation therapy) consists of heparin by intravenous infusion initially, then oral warfarin (Coumadin). Subcutaneous low-molecular weight heparin is substituted for intravenous heparin in many circumstances. Patients who have reactions to heparin or related medications may need other medications.

Patients who cannot tolerate anticoagulation therapy may need an inferior vena cava filter (IVC filter). This device, placed in the main central vein in the abdomen, is designed to block large clots from traveling into the pulmonary vessels. Oxygen therapy may be required to maintain normal oxygen concentrations.

Surgery is sometimes needed in patients at great risk for recurrent embolism.

Expectations (prognosis):

It is difficult to predict how the patient will do in the future. Often, the outlook is related to the disease that puts the person at risk for pulmonary embolism (for example, cancer, major surgery, trauma). In cases of severe pulmonary embolism, where shock and heart failure occur, the death rate may be greater than 50%.

Complications:

• Heart palpitations
• Heart failure or shock
• Severe breathing difficulty
• Sudden death
• Hemorrhage (usually a complication of thrombolytic or anticoagulation therapy)
• Pulmonary hypertension with recurrent pulmonary embolism

Calling your health care provider:

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of pulmonary embolus.