Respiratory Flashcards
Management of suspected or confirmed PE?
New 2020 guidance advises for those in whom PE is suspected:
• Establish is any evidence of haemodynamic instability - if so eg severe hypotension associated with a massive PE = consider for thrombolysis eg with alteplase
• If no haemodynamic instability a DOAC (ie Rivaroxaban / apixaban) can be commenced if PE suspected while waiting for CTPA to confirm
unless contraindicated (eGFR<15 or allergy) and continued if CTPA confirms. DOAC is first line even if patient has active cancer.
• If unable to have a DOAC - use LMWH + dabigatran OR LMWH + warfarin
• If patient has antiphospholipid syndrome should have LMWH + warfarin
Duration of anticoagulation:
• Provoked PE (ie after surgery) = 3 months
• Active cancer = 3-6 months
• Unprovoked PE = 6 months
If repeat PEs despite anticoagulation can consider IVC filter but weak evidence base
Low risk small PEs can be managed at home - assess with PE severity index
