From the Guidelines
Pulmonary embolism (PE) is a life-threatening condition that requires immediate medical attention, and its symptoms include sudden onset of chest pain, shortness of breath, and coughing up blood. The treatment options for PE include anticoagulation therapy, thrombolytic therapy, and surgical intervention, with the goal of preventing further clotting and reducing the risk of recurrent PE 1.
Initial Treatment
The recommended initial treatment for PE is with low molecular weight heparin (LMWH), such as enoxaparin 1mg/kg subcutaneously twice daily, or unfractionated heparin (UFH) with a bolus of 80 units/kg followed by an infusion of 18 units/kg/hour 1. Alternatively, fondaparinux 5mg subcutaneously once daily can be used for patients with a body weight less than 50kg, 7.5mg for patients with a body weight between 50-100kg, and 10mg for patients with a body weight greater than 100kg.
Thrombolytic Therapy
For patients with severe pulmonary embolism, thrombolytic therapy with alteplase 100mg intravenously over 2 hours can be considered 1. This treatment option is recommended for patients with high-risk PE, and it can help to prevent further clotting and reduce the risk of recurrent PE.
Long-term Anticoagulation
Direct oral anticoagulants (DOACs) such as rivaroxaban 15mg orally twice daily for 21 days followed by 20mg orally once daily, apixaban 10mg orally twice daily for 7 days followed by 5mg orally twice daily, or dabigatran 150mg orally twice daily can be used for long-term anticoagulation 1. The duration of anticoagulation therapy should be individualized based on the patient's risk of recurrent pulmonary embolism and anticoagulant-related bleeding.
Surgical Intervention
Surgical intervention, such as surgical pulmonary embolectomy, may be considered for patients with high-risk PE who are not candidates for thrombolytic therapy or who have failed thrombolytic therapy 1.
Some key points to consider when treating PE include:
- The importance of early diagnosis and treatment to reduce the risk of recurrent PE and improve patient outcomes
- The need for individualized treatment plans based on the patient's risk of recurrent PE and anticoagulant-related bleeding
- The use of validated clinical scores, such as the PESI or sPESI, to assess the patient's risk of recurrent PE and guide treatment decisions 1
- The potential benefits and risks of thrombolytic therapy, including the risk of bleeding and the potential for improved patient outcomes.
From the FDA Drug Label
The primary efficacy endpoint was confirmed, symptomatic, recurrent VTE reported up to Day 97.
Table 13. Efficacy of Fondaparinux Sodium in the Treatment of Pulmonary Embolism (All Randomized)
Endpoint Fondaparinux Sodium 5,7.5, or 10 mg SC once daily N = 1,103 Heparin aPTT adjusted IV N = 1,110 n% (95% CI)n% (95% CI) Total VTE a423.8% (2.8,5.1)565. 0% (3.8,6.5) DVT only121.1% (0.6,1.9)171.5% (0.9,2.4) Non-fatal PE141.3% (0.7,2.1)242.2% (1.4,3.2) Fatal PE161.5% (0.8,2.3)151.4% (0.8,2.2)
The symptoms of Pulmonary Embolism (PE) are not explicitly stated in the provided drug label. The treatment options for Pulmonary Embolism (PE) include:
- Fondaparinux sodium 5,7.5, or 10 mg SC once daily
- Heparin intravenous bolus (5,000 USP units) followed by a continuous intravenous infusion adjusted to maintain 1.5 to 2.5 times aPTT control value, in combination with vitamin K antagonist therapy. 2
From the Research
Symptoms of Pulmonary Embolism (PE)
- Dyspnoea (shortness of breath) 3
- Chest pain, particularly pleuritic chest pain 3
- Hypoxia (low oxygen levels) 3
- Sinus tachycardia (rapid heart rate) 3
- Right bundle branch block on electrocardiogram (ECG) 3
- S1Q3T3 pattern on ECG 3
Risk Stratification of PE
- Patients with PE can be stratified into four risk classes: high, intermediate-high, intermediate-low, and low risk 4, 5
- Risk stratification is based on clinical, laboratory, and imaging parameters 4, 5
- Intermediate-risk PE is the most challenging subtype in terms of initial therapeutic choice and long-term management 6
Treatment Options for PE
- Anticoagulation therapy, including non-vitamin K-dependent oral anticoagulants (NOACs) and low molecular weight heparins (LMWHs) 4, 5, 3
- Reperfusion treatment for high-risk patients 4, 5
- Out-of-hospital treatment for low-risk patients 4, 5
- Interdisciplinary "Pulmonary Embolism Response Teams" (PERT) for haemodynamically unstable patients 4, 5
- Supportive care, including critical care of acute right ventricular failure and appropriate follow-up testing after acute PE 7