Pulmonary embolism Flashcards
1
Q
What is the long term management of PE?
A
- LMWH or fondaparinux should be continued for at least 5 days or until the international normalised ratio (INR) is 2.0 or above for at least 24 hours, whichever is longer, i.e. LMWH or fondaparinux is given at the same time as warfarin until the INR is in the therapeutic range
- warfarin should be continued for at least 3 months.
- At 3 months, NICE advise that clinicians should ‘assess the risks and benefits of extending treatment’
- NICE advise extending warfarin beyond 3 months for patients with unprovoked PE. This essentially means that if there was no obvious cause or provoking factor (surgery, trauma, significant immobility) it may imply the patient has a tendency to thrombosis and should be given treatment longer than the norm of 3 months
- for patients with active cancer NICE recommend using LMWH for 6 months
Thrombolysis:
- thrombolysis is now recommended as the first-line treatment for massive PE where there is circulatory failure (e.g. hypotension). Other invasive approaches should be considered where appropriate facilities exist
- In such a situation unfractionated heparin should be used.
2
Q
What is the recommendation for patients with repeated PEs despite adeqaute anticoagulation?
A
- inferior vena cava (IVC) filters
- work by stopping clots formed in the deep veins of the leg from moving to the pulmonary arteries
- IVC filter use is currently supported by NICE but other studies suggest a weak evidence
