Pulmonary embolism - Treatment & therapy

Print Size

Treatment & therapy of pulmonary embolism

If you suspect you or someone else has a pulmonary embolism, please contact the emergency doctor immediately.  Until then, the patient should move as little as possible. In case of cardiac arrest, resuscitation procedures should be started immediately. In case of shortness of breath, reclining the person with the slightly lifted upper body, as well as administration of oxygen can be helpful.

The emergency doctor will start with an artificial resuscitation.  Depending on the symptoms, the doctor administrates pain and calming or circulation stabilizing medicine to the patient. With Heparin, it is attempted to dissolve blood clots as fast as possible.  For any further treatment, transport to the hospital is necessary. 

Depending on the severity of the disease, the following measures are taken into consideration:

  • Use of anticoagulant medication:  In 80 percent of the cases, this measure is enough to avoid further thrombosis in the leg and pelvis arteries. The thrombus in the lung is dissolved by the body in milder cases. Heparin is administered for about ten days as infusions or injections, and later the patient takes pills themselves.
  • Dissolution of the blood clot (fibrinolysis):  With more severe forms of pulmonary embolism, a self dissolution of the blood clot cannot be done by the body and right heart failure is a risk.  The substances administered into the veins dissolve the thrombus in the lung (lyse therapy).  The associated high bleeding risk of other organs must be taken into account. 
  • Catheter treatment: This therapy is also used in severe cases. Using a catheter inserted through the veins into the right heart and finally into the lung, the thrombus is crushed mechanically.  This large lung embolism then becomes several smaller embolisms, which can be better handled by the heart. In addition, a lyse therapy can be carried out. Possible complications are vein injuries and bleeding.  The prerequisite for this treatment is a clinic where a catheter lab is available within a short time. 
  • Surgery: If none of the measures mentioned above help, the clot can also be removed through surgery (pulmonary embolectomy). For this, the use of a heart-lung machine is necessary.

After the acute treatment new, lung embolisms, resp. thrombosis must be prevented.  Depending on the risk factors and severity of the illness, the so-called coumarins must be applied over a varyingly long period of time. Mostly this is about three to six months.  In case of a permanently increased risk, you must take medication for the rest of your life. Since this therapy increases the probability of bleeding, the intake must be monitored and discussed regularly. Newer preparations are better tolerated and easier to dose.