pulmonary embolism treatment

pulmonary embolism treatment

 Diagnosis and treatment of pulmonary embolism

    

Summary
Pulmonary embolism Symptoms and complications Risk factors Causes and prevention Diagnosis and treatment Sources and references
How does the doctor diagnose pulmonary embolism?
Faced with a patient who has symptoms suggestive of pulmonary embolism, the doctor will look for possible risk factors (for example, a history of phlebitis or recent surgery) and request a series of additional tests to confirm his diagnosis. While waiting for their results, they can decide to put in place an anticoagulant treatment if the symptoms seriously evoke a pulmonary embolism. He will also look for signs of phlebitis in the legs.

Complementary examinations are essentially a scan of the pulmonary blood vessels ("angioscanner"), an electrocardiogram and a measurement of the blood gases (blood gas). The doctor also asks for the blood test of a substance present in the clots, the "D-dimer". A low level of D-dimer in the blood eliminates the possibility of pulmonary embolism (but a high rate does not confirm it). Other medical imaging examinations (for example, pulmonary scintigraphy) may be performed.

In a patient under 45, a search for an inherited bleeding disorder is also conducted.

How is pulmonary embolism treated?
The treatments for pulmonary embolism are aimed at:

restore blood circulation in the blocked pulmonary artery;
if necessary, relieve the heart and restore normal oxygen levels in the blood;
prevent complications and recurrences.
For this, the doctor has anticoagulant drugs and possibly drugs to dissolve the clot. The patient can also receive oxygen supplementation and medications to relieve and strengthen heart function.

If embolism often requires hospitalization in the intensive care unit, it remains short once the anticoagulant treatment is in place and the danger of complications is eliminated. On the first day, the patient remains with his legs elevated, but he must quickly get up, move and wear compression stockings.

Anticoagulant drugs against pulmonary embolismDrugs intended to reduce the blood clotting ability are essentially of two types:

antivitamins K, called "AVK", such as acenocoumarol, fluindione or warfarin, which are the oldest and most commonly used over long periods. They block the action of vitamin K, essential for blood clotting, and are administered orally.
heparins, substances derived from an anticoagulant substance present in our body. We distinguish the unfractionated standard heparins (heparin sodium and heparin calcium), older, low molecular weight heparins (LMWH, dalteparin sodium, enoxaparin sodium, tinzaparin sodium). A derivative of heparin, fondaparinux sodium, is also part of this family. These substances are administered by injections under the skin or directly into a vein.
Recently came another family of anticoagulant substances, direct oral anticoagulants (apixaban, rivaroxaban). They are also used in the treatment of pulmonary embolism.

How are anticoagulants used in the treatment of pulmonary embolism?
Most often, the treatment of pulmonary embolism begins with the administration of heparin, fondaparinux sodium, or direct oral anticoagulants (depending on the patient's peculiarities and the severity of the embolism). This treatment is continued for five to nine days.
If treatment with heparin or fondaparinux, treatment with antivitamin K (oral anticoagulant) is initiated from the first day (it will take about a week to effectively control coagulation). Anticoagulant therapy is contraindicated in people who have recently had a stroke or who are at high risk of bleeding.
The main risk of any anticoagulant treatment is the occurrence of bleeding, either as a result of cuts or blows, or spontaneously (digestive bleeding for example). This effect is related to the mode of action of anticoagulants. For this reason, medical supervision is necessary during treatment. The patient is informed of the precautions to be taken during treatment with anticoagulants and a specific tracking book is given to him.
Oral anticoagulant therapy will be maintained for a period of three to six months, or permanently if the patient has a predisposition to venous thromboembolic disease.
Thrombolysis in the treatment of pulmonary embolism
When pulmonary embolism is severe, if it is likely to cause shock or cardiac arrest, or if it causes a significant drop in blood pressure, it may be necessary to seek to dissolve the blocked clot as soon as possible. in the pulmonary artery.

To achieve this, there are intravenous treatments based on enzymes capable of digesting the clot, "thrombolytic" drugs: alteplase, streptokinase and urokinase. A single injection is usually sufficient.

Embolectomy in the treatment of pulmonary embolism
Embolectomy, or thrombectomy, involves surgically removing the clot that obstructs the pulmonary artery. This mode of treatment is reserved for patients with severe embolism, threatening to cause cardiac arrest, and in whom thrombolysis is not possible or has remained ineffective. This gesture remains exceptional.