Blood Thinners (Anticoagulation)

Medication will be prescribed to you that will prevent the formation of new blood clots. This medicine must be taken every day as you doctor prescribes it. You will likely have to take the medicine for 3-6 months, but possibly longer depending on your risk factors. Antiocoagulation medications can be taken in pill form, or may require an injection. Some medications require regular blood tests to monitor its effectiveness. Your doctor will discuss the options with you.

Systemic Thrombolysis

Thrombolytics are intravenous medications that break down clot. They are sometimes called “clot busters.” When there is a large, life threatening blood clot in the lungs, thrombolytics are given in a large dose to break down the clot quickly. Unfortunately, this medicine travels throughout the body, so there is a risk of causing bleeding. In some cases, the benefit of breaking up the clot exceeds the risk of bleeding.

Catheter-Directed Thrombolysis

This procedure is performed by an interventional radiologist and is best performed as soon as possible after a PE is diagnosed. During this procedure, ultrasound and x-rays are used to guide a small catheter (tube) through the veins and the heart and into the affected blood vessels in your lungs. Once the catheter is in place, a thrombolytic (clot busting) drug is administered directly into the clot which dissolves the clot. This technique offers the advantage of using much smaller doses of medication and delivering it directly to the clot. Often patients need to spend the night in the intensive care unit (ICU) while the medicine is being given. Some patients may receive a head CT before the procedure to make sure there is not an increased risk for bleeding. By removing the clot quickly, it is hoped that symptoms will improve and long term complications will be avoided.

Inferior Vena Cava Filter Placement

If a patient cannot be treated with blood thinners (due to an increased risk of bleeding) and is not felt to be a candidate for catheter-directed thrombolysis, then placement of an Inferior Vena Cava Filter may be indicated. Filters can also be placed in patients who are felt to be at significantly increased risk for recurrent PE who would be unable to tolerate a second pulmonary embolism. A filter is a small device that is placed directly into the Inferior Vena Cava, which is the main vein draining blood from both legs. The filter stays within this vein and traps clot that travels from the legs before it is able to reach the lungs. Filters can be a permanent device, but often they are removed when they are no longer needed.