Treatment options for pulmonary embolism include:
Anticoagulants are often referred to as "blood thinners," although they don't actually thin the blood. While these drugs do not dissolve a clot, they can stabilize it by allowing the clot to stick to the vein wall, thereby avoiding pulmonary embolism and allowing the body to eliminate or partially dissolve the clot over time. Examples of anticoagulants include warfarin (Coumadin) and heparin.
Rarely are the symptoms of deep vein thrombosis or pulmonary embolism so severe that more aggressive treatment is needed. Medications that rapidly dissolve blood clots, called thrombolytics, are used selectively in individual patients in severe cases of DVT or PE. Thrombolytics are used in patients with severe cases of pulmonary embolism when extensive blood clots in the lung result in acute heart failure or acute lung failure. Thrombolytics are given by endovascular specialists in the hospital and require close observation throughout the time they are delivered due to an infrequent, but potentially serious risk of bleeding.
Filters are mechanical devices that "catch" deep vein thrombosis (DVT) clots that are released from the leg or pelvis and are traveling toward the lungs where they would cause pulmonary embolism. Filters are used in situations where a patient may need additional protection from clots that can result in pulmonary embolism. They may also be used when "blood thinners" are not effective or when a patient cannot receive anticoagulation. They are placed in the large vein of the abdomen (the inferior vena cava, commonly called the IVC) that receives the blood from both legs returning to the heart and lungs. This filter is placed by an endovascular specialist. The endovascular specialist advances a small tube containing the filter into a vein in the groin, neck or arm to the intended site in the IVC where the filter is released allowing it to open fully and attach to the walls of the IVC. From its position in the IVC, clots escaping from either leg or from the pelvis veins can be trapped. Some types of IVC filters are permanent, while others can be removed when the risk of pulmonary embolism has passed.
Also called clot busters, these medications are given intravenously to break down the clot.
Vena cava filter
A vena cava filter is a small metal device placed in the large blood vessel that
returns blood from the body to the heart may be used to prevent clots
from traveling to the lung. These filters are generally used in patients
who cannot receive anticoagulation treatment for medical reasons, who
develop additional clots even with anticoagulation treatment or who
develop bleeding complications from anticoagulation.
Pulmonary embolectomy is surgical removal of a pulmonary embolism.
This procedure is generally performed only in severe situations in which
the PE is very large, the patient either cannot receive anticoagulation
and/or thrombolytic therapy due to other medical considerations or has
not responded adequately to those treatments, and the patient's
condition is unstable.
During a percutaneous thrombectomy a catheter is inserted into the site of the embolism, using X-ray guidance. Once the
catheter is in place, the catheter is used to break up the embolism,
extract it or dissolve it by accommodating an injection of thrombolytic
An important aspect of treatment of pulmonary embolism is prophylactic treatment to prevent formation of additional embolisms.