Pulmonary embolism – therapy and course

Pulmonary embolism - therapy and course

In the case of a pulmonary embolism, a blood clot, a so-called thrombus, is washed into an artery in the lungs and can block it. The pressure in the pulmonary circulation increases and the heart is subjected to a more significant load. As a result, the blood pressure drops, the organs are no longer supplied with blood adequately, and the body lacks oxygen. This condition can quickly become life-threatening. If a pulmonary embolism is present, medical treatment must be sought immediately. What is the therapy for a pulmonary embolism, how does the disease progress and can a pulmonary embolism be prevented?

What acute therapy is there for pulmonary embolism?

A pulmonary embolism must always be treated in the hospital. Suppose typical symptoms of a pulmonary embolism, such as shortness of breath and chest pain, occur at home. In that case, the emergency call should be made immediately, and the affected person should lie half-sitting. This position reduces blood flow through the veins to the heart.

As a primary measure of therapy, painkillers and sedatives, as well as oxygen, are administered, possibly also substances that stabilize the circulation. 

In addition, the medical staff will use a so-called validated clinical score (sPESI) in stable patients to determine possible risks and use them to determine how to proceed. Blood pressure, respiratory rate and temperature are measured and known previous illnesses and age are queried.

 

treatment with medication

Anticoagulant drugs such as heparin are given intravenously or injected to prevent the blood clot from growing further or forming new clots. These blood-thinning agents are also called anticoagulants.

At the same time, pulmonary embolism therapy is started with anticoagulant tablets, which – depending on the risk factors – must be taken for three to six months or life. These agents are referred to as direct oral anticoagulants (DOAK), the general use of anticoagulants to treat or prevent disease as part of long-term anticoagulation therapy.

Possible side effects of this treatment include an increased risk of bleeding, which can affect different areas, such as the gastrointestinal tract or muscle tissue.

Vitamin K antagonists as an alternative

Vitamin K antagonists can be used as an alternative to DOAK. However, these are only used if complaints occur due to the use of DOAK or if certain illnesses speak against the use of DOAK. These include, for example, antiphospholipid syndrome or mitral stenosis.

 

thrombolysis in severe cases

The blood clot must be dissolved if it is a severe pulmonary embolism. This form of therapy is called lysis therapy or thrombolysis. For this purpose, particular drugs are used, the so-called fibrinolytic.

Fibrins are an essential part of blood clotting. The fibrinolytic breaks down the proteins, and the blood clot dissolves. Since fibrinolytics increase the tendency to bleed in other organs, they are usually only used if there is already a risk of heart failure due to pulmonary embolism.

Treatment by mechanical intervention

The body can dissolve smaller clots in the blood itself, but larger ones may have to be helped artificially. For this purpose, drugs are administered as an infusion, or the blocked vessel is freed with an inserted catheter. To do this, the catheter is inserted into the affected pulmonary vessel, and the blood clot is broken up.

If all other treatment options have failed, there is still an attempt to remove the clot as part of an operation surgicallyThis operation is called a thromboendarterectomy. The affected artery is exposed, and the blood clot is removed.

Is bed rest recommended?

Bed rest for pulmonary embolism has been prescribed in some cases in the past but should not be followed after successful treatment because immobility can increase the risk of thrombosis. As soon as the health of those affected allows it, they should move again.

 

What is the course of a pulmonary embolism?

Pulmonary embolism is a dangerous disease – even with timely diagnosis and treatment, the mortality rate is still five to ten per cent. The risk of death is exceptionally high in the first two hours after the onset of symptoms.

If the affected person survives, it takes about four weeks to heal because the body’s system can usually remove the blood clots during this time. However, about half of those affected experience long-term effects of the disease, such as persistent breathing problems (dyspnea) and fatigue.

There is also a recurrence in about one-third of the patients, i.e., renewed venous thrombosis or pulmonary embolism. Therefore, preventive medication must be taken as described above.

Measures to prevent pulmonary embolism

Sometimes, a wire mesh (cava umbrella) can be inserted into the portal vein, which acts as a filter to intercept the thrombi in the bloodstream before they reach the lungs. In addition, some various measures and behaviors can be used to prevent the recurrence of a thrombosis:

  • Wear compression stockings regularly, which should be prescribed and accurately fitted.
  • Drink enough liquid (no alcohol!).
  • Move your legs and feet frequently. Appropriate gymnastic exercises can be shown by medical or therapeutic staff.
  • Physiotherapy to improve lung function, such as rehabilitation treatment, can also be appropriate.
  • If possible, reduce risk factors such as smoking, little exercise or taking the pill as a contraceptive.

Before long flights (especially if they last more than six hours), you should discuss with your family doctor whether a preventive dose of heparin, for example, makes sense.

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