Pulmonary Embolism Treatment

Question 1

What is pulmoary embolism

Answer 1

What is it?

a blood clot in the artery of the lungs as a result of a dislodged blockage

Question 2

Signs and Symptoms of PE

Answer 2

Signs and Symptoms

cough, chest pain, tightness, sob

dyspnea, tachypnea, and tachycardia

elevated d-dimer

Question 3

Classifications of Pulmonary Embolisms

Answer 3

Classifications of Pulmonary Embolisms
(describes severities of symptoms)

1.Low risk- PE not getting other criteria

2. Sub-massive
   a. right ventricular strain
   I. seen on ECHO
   II.+ troponin
   III. +BNP
3. Massive
   I. systolic BP <90 mmhm or decrease of 40 mmHg from baseline
   II. requiring vasopressors
   III. pulseless

Question 4

PE acute treatment based on classification

Answer 4

PE acute treatment based on classification

1. Low risk
   a. Therapeutic Anticoagulation (treat exactly as if they had DVT)
2. submassive
   a. catheter directed thrombolytics(CDT), then therapeutic anticoagulation
3. Massive
   a. IVthrombolytics then therapeutic anticoagulation

NOT SET IN STONE, BUT THIS IS WHAT GENERALLY HAPPENS, but some submissive will get IV thrombolytics, and some massive ill get catheter directed thrombolytics

Question 5

Thrombolytics

Class:

Indication:

Examples:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

Pearls.

Answer 5

Thrombolytics

Class: Thrombolytic

Indication:Pulmonary Embolism

Examples: Alteplase (tPA), Reteplase, Tenecteplase

Mechanism of Action: binds to fibrin in a rhombus (clot) and converts entrapped plasminogen into plasmin. Plasmin degrades clots

Effects of mechanism of Action: initiates local fibrinolysis

Adverse Effects: bleeding

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

Question 6

Catheter Directed Thrombolytics (CDTs)

what is it?
what meds are used?
what are the types?

Answer 6

Catheter Directed Thrombolytics (CDTs)

1. used to break up clots
2. insert catheter into clot and holes i catheter deliver medications and break up the clot
3. meds used: Heparin and Alteplase

4.Types of CDT :Unifuse without ultrasound, EKOS with ultrasound (more efficient at breaking up clots)

Question 7

Anticoagulant treatment for PE and no cancer

Answer 7

same as DVT

1. Doacs>VKA>LMWH
2. if PE was unprovoked and anticoagulant therapy stopped, use aspiRIN

Question 8

Treatment Length OF VTE

Answer 8

Treatment Length

Same as DVT

1B: Patients with proximal DVT or PE: 3 months of anticoagulant therapy

1B-2B: in patients with unprovoked DVT
I. low-moderate bleeding risk, extended anticoagulant therapy (no schedule stop date)
II> high bleeding risk: 3 months of anticoagulant therapy

1B-2B: in pts with DVT of leg or PE and active cancer, we recommend extended anticoagulant therapy (no schedule stop date)