From the Guidelines
If you suspect your pulmonary embolism (PE) treatment plan has been derailed, you should contact your healthcare provider immediately as this is potentially life-threatening. The standard treatment for PE typically involves anticoagulation therapy with medications like low molecular weight heparin (enoxaparin 1mg/kg twice daily or 1.5mg/kg once daily), unfractionated heparin, or direct oral anticoagulants (DOACs) such as rivaroxaban (15mg twice daily for 21 days, then 20mg daily), apixaban (10mg twice daily for 7 days, then 5mg twice daily), or edoxaban, with a preference for anticoagulation with a NOAC over the LMWH–VKA regimen unless the patient has contra-indication(s) to NOACs 1.
Key Considerations
- Treatment usually continues for at least 3-6 months, with duration depending on whether your PE was provoked by a temporary risk factor or unprovoked.
- Signs that your treatment may be off track include worsening shortness of breath, chest pain, coughing up blood, increased leg swelling, or bleeding complications from anticoagulants.
- Never stop anticoagulation without medical supervision, as this significantly increases your risk of recurrent PE.
- If you're experiencing bleeding complications, your doctor may need to adjust your medication dosage or switch to a different anticoagulant.
- Anticoagulants work by preventing further clot formation while your body naturally dissolves existing clots, protecting you from the potentially fatal consequences of untreated PE.
High-Risk PE
For patients with high-risk PE, thrombolytic therapy is recommended 1, and the best reperfusion option (systemic thrombolysis, surgical embolectomy, or catheter-directed treatment) should be selected considering the resources and expertise available at the hospital 1.
Follow-Up
After acute PE, patients should not be lost to follow-up, and regular follow-up examinations are recommended to check for possible signs of VTE recurrence, cancer, or bleeding complications of anticoagulation, and to detect/treat comorbidity or ‘simple’ deconditioning 1.
From the FDA Drug Label
1.4 Treatment of Pulmonary Embolism Apixaban tablets are indicated for the treatment of PE.
2.1 Recommended Dose Treatment of DVT and PE The recommended dose of apixaban tablets is 10 mg taken orally twice daily for the first 7 days of therapy. After 7 days, the recommended dose is 5 mg taken orally twice daily.
The treatment plan for a pulmonary embolism (PE) with apixaban is to take 10 mg orally twice daily for the first 7 days, then 5 mg orally twice daily after 7 days 2.
- 3 Treatment of Pulmonary Embolism XARELTO is indicated for the treatment of pulmonary embolism (PE).
However, the rivaroxaban label does not provide a specific dosage for the treatment of PE, only that it is indicated for this use 3.
From the Research
Treatment Plan for Pulmonary Embolism (PE)
The treatment plan for pulmonary embolism (PE) involves several strategies, including:
- Risk stratification to determine the severity of the condition 4, 5, 6
- Anticoagulation therapy to prevent further clotting 4, 7, 6
- Supportive care to manage symptoms and prevent complications 4
- Interventional treatments, such as thrombectomy or thrombolytic therapy, for high-risk patients 5, 7
Anticoagulation Therapy
Anticoagulation therapy is a crucial component of PE treatment, and may involve:
- Parenteral anticoagulants, such as heparin, in the acute phase 7, 6
- Oral vitamin K antagonists (VKAs) for long-term anticoagulation 7
- Direct oral anticoagulants (DOACs), such as rivaroxaban, apixaban, and edoxaban, which offer a potentially improved safety profile and simplified treatment regimen 7, 6
Interventional Treatments
Interventional treatments, such as thrombectomy or thrombolytic therapy, may be necessary for high-risk patients with massive or submassive PE 5, 7
- These treatments aim to rapidly restore blood flow and prevent further clotting 5
- Clinical evidence supports the use of endovascular treatment modalities in selected patients with PE 5
Follow-up and Extended Treatment
Follow-up testing and extended treatment are essential to prevent recurrent PE and manage long-term complications 4, 7, 8