Pulmonary Embolism

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.

Also called clot busters, these medications are given intravenously to break down the clot.

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.

During a percutaneous thrombectomy a catheter is inserted into the site of the embolism, using X-ray guidance. Once the catheter is in place, it is used to break up or extract the embolism or dissolve it by injecting thrombolytic medication.

An important aspect of treatment of pulmonary embolism is prophylactic treatment to prevent formation of additional embolisms.

Pulmonary embolectomy (PE) is the surgical removal of a pulmonary embolism. This procedure is generally performed in severe situations in which: 

• The PE is very large. 
• The patient cannot receive anticoagulation or thrombolytic therapy due to other medical considerations. 
• That patient has not responded adequately to anticoagulation or thrombolytic therapy and is not in stable condition.

Medications that rapidly dissolve blood clots, called thrombolytics, are used selectively in patients with severe deep vein thrombosis or pulmonary embolism (PE) - when extensive blood clots in the lung result in acute heart failure or acute lung failure.

Endovascular specialists administer thrombolytics in the hospital to closely monitor patients for an infrequent but potentially serious risk of bleeding.

A vena cava filter is a small metal device placed in the large blood vessel that returns blood from the body to the heart to prevent clots from traveling to the lung. These filters are generally used in patients who cannot receive anticoagulation treatment for medical reasons, develop additional clots even with anticoagulation treatment, or develop bleeding complications from anticoagulation.