Pulmonary embolism treatment

In the event of a cardiac arrest, start resuscitation measures immediately: Cardiac massage, mouth-to-mouth resuscitation. Continue to do this until the emergency service arrives.

Treatment is started immediately: half-sitting position so that the patient can breathe more easily, painkillers and sedatives, blood-thinning medication and oxygen. The therapy is continued in hospital. Which treatments are considered depends on the severity of the pulmonary embolism. You will find an overview of all treatment options below.

Anticoagulant medication (anticoagulants)

• Doctors generally use the active ingredient heparin initially. It inhibits blood clotting and prevents the blood clot from growing, detaching or forming new thrombi. Patients receive heparin as an injection or infusion over several days. An alternative is heparin analogs, for example the active ingredient fondaparinux.
• Vitamin K antagonists (coumarins): These drugs replace heparin a few days later and also slow down blood clotting and pulmonary embolism. Frequently used active substances are phenprocoumon or warfarin. Patients take them in tablet form for several months, sometimes even years. However, regular blood coagulation tests are necessary to check the dose of medication.
• New oral anticoagulants(NOAKs): These drugs are available as tablets and are considered an alternative to coumarins. Apixaban, dabigatran or rivaroxaban, for example, are used. They prevent new blood clots and pulmonary embolism. No regular blood clotting checks are necessary. As new oral anticoagulants are more convenient and safer (bleeding complications) than vitamin K antagonists, they are predominantly used today. There are exceptions for patients with advanced liver or kidney dysfunction.

Lysis therapy: dissolving the blood clot

If the pulmonary embolism is severe, doctors will try to reduce or dissolve the blood clot with medication. In this case, it is not enough just to inhibit blood clotting. The aim is to quickly reopen the blocked blood vessel, allow the blood to flow freely again and relieve the right heart. Lysis therapy, thrombolysis or fibrinolysis are the technical terms for this treatment. So-called thrombolytics are used, for example the active substances urokinase, streptokinase or alteplase (recombinant tissue plasminogen activator, rtPA). Lysis therapy can cause severe bleeding, for example in the brain or gastrointestinal tract. An interdisciplinary team at the University Hospital Zurich consisting of specialists in emergency medicine, angiology, cardiology and cardiac and thoracic surgery decides whether clot removal is necessary.

Removing blood clots: catheter or open surgery

Doctors can also remove the blood clot in the lung using a catheter, which they carefully advance to the affected vessel. Small instruments or ultrasound are used to break up the blood clot. Additional medication (local lysis therapy) then dissolves it. Compared to systemic lysis treatment (medication is administered via a vein in the arm), significantly smaller quantities of thrombolytics are used in catheter lysis. This can significantly reduce the risk of bleeding. If removal using a catheter is not successful, open surgery is an option. However, it is associated with greater risks and doctors only perform it in exceptional situations. In rare cases, heart-lung machines (so-called extracorporeal lung support) must be used, which temporarily take over the circulation and oxygen intake function of the heart and lungs.