Where a clot breaks off and gets lodged in lungs. Most commonly from a Deep Vein Thrombosis
Causes/Factors
- Same as Deep Vein Thrombosis
- Thrombophilia
- Malignancy
- polycythaemia
Symptoms
- Acute dyspnoea
- Pleuritic pain
- Haemoptysis
- Syncope
Signs
- Pyrexia - usually low grade
- Cyanosis
- Sinus tachycardia (other ECG changes)
- Tachypnoea (may lead to resp alkalosis)
- Hypotension
- Raised JVP
May also have signs and symptoms of DVT
Diagnostic Tests
- Low
- Low
- elevated D-dimer (non specific)
- normal chest exam
- CXR - is usually normal in a pulmonary embolism but is required to rule out other pathology.
Wells score
-
4+ perform a CTPA or alternative
-
<4 perform a D-dimer and if positive get a CTPA
-
CTPA - 1st line diagnostic
-
V/Q scan
Management
- Oxygen & analgesia PRN
Anticoagulation for haemodynamically stable PEs:
- DOAC - apixaban or rivaroxaban first line
- LMWH main alternative (e.g. in Kidney Failure patients)
Massive PE with haemodynamic compromise one of
-
Continuous infusion of unfractionated heparin
-
Consider thrombolysis (Streptokinase, alteplase, tenecteplase) first line
-
May consider continuous infusion of unfractionated heparin
Long-Term Anticoagulation
The options for long-term anticoagulation in VTE are a DOAC, warfarin or LMWH.
- DOACs (-xbans & dabigatran) are first line and are suitable for most patients - exceptions in extreme renal impairment.
- Warfarin - target INR 2-3 for treating DVTs and PEs. First line in patients with Antiphospholipid syndrome
- Low molecular weight heparin (LMWH) is first line in Pregnancy
Continue anticoagulation for:
- 3 months with a reversible cause (then review)
- 3+ months with unprovoked, recurrent VTE or irreversible underlying cause
- 3-6 months in active cancer