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Pulmonary embolism

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Respiratory System

Pulmonary embolism is a condition that occurs when an artery in your lung becomes blocked. In most cases, the blockage is caused by one or more blood clots that travel to your lungs from another part of your body.

Most blood clots originate in your legs, but they can also form in the veins of your arms, the right side of your heart or even at the tip of a catheter placed in a vein. In rare cases, other types of clots - such as globules of fat, air bubbles, tissue from a tumor or a clump of bacteria - also can lodge in your lungs' arteries.

Smaller clots prevent adequate blood flow to the lungs, sometimes causing damage to lung tissue (infarction). Large clots that completely block blood flow can be fatal.


Prompt treatment of venous thromboembolism — the term used to refer to both pulmonary embolism and deep vein thrombosis — is essential in order to prevent serious complications or death. At first you'll likely receive oxygen and the fast-acting anticoagulant heparin, which helps prevent existing clots from growing and stops the formation of new ones. Your doctor is also likely to prescribe the anticoagulant warfarin (Coumadin). It, too, helps stop clot formation, but works less quickly than heparin.

After the original clot has dissolved, you'll likely continue to take an anticoagulant medication. How long depends on your particular case. If you have a chronic disorder that puts you at high risk of pulmonary embolism, you may need to take these drugs indefinitely. In general, though, you only take them for a limited time — usually at least six months. Results of a study released in February 2003 suggest that indefinite, low-dose treatment with warfarin prevents the recurrence of pulmonary embolism and of deep vein thrombosis. The study, conducted by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, involved more than 500 participants. The study began in 1998 and was scheduled to run until 2005, but NHLBI ended the study early because it showed such a high degree of benefit from using warfarin.

As with all medications, the benefits of anticoagulants need to be weighed against the risks. Heparin and warfarin reduce your chance of developing blood clots. But because they may also prevent normal blood coagulation, they increase your risk of bleeding complications. Many of these complications are minor, such as bleeding from your gums, but some may be severe and life-threatening. If you take warfarin, your doctor will ask you to have periodic blood tests to check how well the drug is working as well as tests for hidden (occult) blood in your stool.

During anticoagulant therapy, avoid using aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others), which also affect your blood's ability to clot. Because many other drugs, including over-the-counter medications and some herbs, can interact with anticoagulants, be sure your doctor knows all the medications you're taking, and check with your doctor or pharmacist before taking any new medication.

When pulmonary embolism is life-threatening
If you experience a massive pulmonary embolism or recurring emboli or have pre-existing cardiopulmonary disease or if other treatments aren't effective, one of the following therapies may be an option:

  • Clot-dissolving (thrombolytic) therapy. Rather than simply preventing clot formation, medications such as streptokinase, urokinase and the tissue plasminogen activator alteplase actually dissolve clots. They work by activating an enzyme that breaks down blood clots and are sometimes popularly referred to as "clot-busters." You're not a candidate for these drugs if you're pregnant, have had a recent stroke, have severe high blood pressure or have undergone surgery within the past 10 days. Thrombolytic medications increase your risk of bleeding, especially from recent wounds, at needle puncture sites and in your digestive tract, but bleeding can occur anywhere, including your gums when you brush your teeth. Some bleeding may be fatal.

  • Vein filter. To prevent clots from being carried into your pulmonary artery, a radiologist may place a filter that looks like an open umbrella frame in the main vein (inferior vena cava) in your abdomen leading from your legs and pelvis to the right side of your heart. This is done with a catheter inserted through your neck or leg vein.


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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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