What is the treatment for Pulmonary Embolism (PE)?

From the Guidelines

The primary treatment for pulmonary embolism (PE) is anticoagulation therapy, which should be initiated without delay, and for most patients, low-molecular-weight heparin (LMWH) or fondaparinux is recommended over unfractionated heparin (UFH) 1. When initiating anticoagulation, it is crucial to consider the clinical probability of PE and start treatment while diagnostic workup is in progress.

• Key considerations for anticoagulation include:
  • Initiation of anticoagulation without delay in patients with high or intermediate clinical probability of PE 1
  • Preference for LMWH or fondaparinux over UFH for most patients 1
  • Use of direct oral anticoagulants (DOACs) such as apixaban, dabigatran, edoxaban, or rivaroxaban in preference to vitamin K antagonists (VKAs) when oral anticoagulation is started 1
• For hemodynamically unstable patients with high-risk PE, systemic thrombolytic therapy is recommended 1, and surgical pulmonary embolectomy or percutaneous catheter-directed treatment should be considered for patients in whom thrombolysis is contraindicated or has failed 1.
• It is also important to note that routine use of primary systemic thrombolysis is not recommended in patients with intermediate- or low-risk PE 1, and the use of NOACs is not recommended in patients with severe renal impairment, during pregnancy and lactation, and in patients with antiphospholipid antibody syndrome 1.
• Monitoring for bleeding complications and signs of recurrent PE, as well as educating patients on adherence to anticoagulation therapy and potential side effects, are crucial aspects of management.
• The goal of anticoagulation is to prevent further clot formation and allow the body's natural fibrinolytic system to dissolve existing clots, reducing the risk of recurrent PE and long-term complications such as chronic thromboembolic pulmonary hypertension.

From the FDA Drug Label

1 INDICATIONS & USAGE

1. 4 Treatment of Pulmonary Embolism Apixaban tablets are indicated for the treatment of PE.

1 INDICATIONS AND USAGE

1. 3 Treatment of Pulmonary Embolism XARELTO is indicated for the treatment of pulmonary embolism (PE).

The treatment for Pulmonary Embolism (PE) is:

• Apixaban (PO) 2
• Rivaroxaban (PO) 3

From the Research

Treatment Options for Pulmonary Embolism (PE)

The treatment for Pulmonary Embolism (PE) typically involves anticoagulant therapy to prevent death from the existing embolus, prevent death and morbidity from recurrent pulmonary embolism, and prevent morbidity from recurrent deep-vein thrombosis 4, 5. The primary objective for patients with adequate cardiorespiratory reserve is to prevent recurrent pulmonary embolism.

Anticoagulant Therapy

• Unfractionated heparin has documented efficacy in reducing mortality and recurrent thromboembolic events in patients with pulmonary embolism or symptomatic proximal deep venous thrombosis 4.
• Low-molecular-weight heparin (LMWH) is as effective as unfractionated heparin for the treatment of patients with deep-vein thrombosis and submassive pulmonary embolism, with the advantage of fixed-dose administration by subcutaneous injection 4, 5, 6.
• Direct oral anticoagulant drugs (DOACs) are becoming the agents of first choice for initial treatment of PE due to their simplicity and non-inferiority to standard therapy 7.

Treatment Settings

• Outpatient treatment with LMWH is feasible in many patients and offers potential cost-savings and improvements in health-related quality of life 6, 8.
• Clinical practice guidelines recommend the use of LMWH or fondaparinux as initial therapy for most patients with deep venous thrombosis or pulmonary embolism, with unfractionated heparin generally recommended for patients with renal failure 4.

Thrombolysis

• Thrombolytic therapy may be useful in cases of massive pulmonary embolism, but more evaluation is needed 4.
• Thrombolysis is recommended for massive pulmonary embolism and, in some guidelines, for iliofemoral venous thrombosis 4.