Pulmonary Embolism (cont.)

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Venous Doppler study

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Ultrasound of the legs, also known as venous Doppler studies, may be used to look for blood clots in the legs of a patient suspected of having a pulmonary embolus. If a deep vein thrombosis exists, it can be inferred that chest pain and shortness of breath may be due to a pulmonary embolism. The treatment for deep vein thrombosis and pulmonary embolus is generally the same.

Echocardiography (EKG, ECG)

Echocardiography or ultrasound of the heart may be helpful if it shows that there is strain on the right side of the heart.

If non-invasive tests are negative and the healthcare provider still has significant concerns, then the healthcare provider and the patient need to discuss the benefits and risks of treatment versus invasive testing like angiography.

What is the treatment for pulmonary embolism?

The best treatment for a pulmonary embolus is prevention. Minimizing the risk of deep vein thrombosis is key in preventing a potentially fatal illness.

The initial decision is whether the patient requires hospitalization. Recent studies suggest that those patients with a small pulmonary embolus, who are hemodynamically stable (normal vital signs) and who can be compliant with treatment, may be treated at home with close outpatient care.

Those who are unstable need to be admitted to the hospital.


The first step in stable patients with pulmonary embolism is anticoagulation. This is a two step process. Warfarin (Coumadin) is the drug of choice for anti-coagulation. It is taken by mouth beginning immediately upon the diagnosis of pulmonary embolism, but may take up to week for the blood to be appropriately thinned or anticoagulated. As an immediate solution and as a bridge until the Coumadin becomes effective, low molecular weight heparin (enoxaparin (Lovenox) or pentasaccharide (Fondaparinux, Arixtra) is administered at the same time. It thins the blood via a different mechanism. Enoxaparin or Fondaparinux injections can be administered as an outpatient.

For those patients who have contraindications to the use of enoxaparin (Lovenox) (for example, kidney failure does not allow the drug to be metabolized), intravenous heparin can be used as the first step. This requires admission to the hospital and careful patient monitoring with blood tests.

Anticoagulation is usually suggested for a minimum of six months, but each patient will have their treatment regimen individualized. The blood test utilized to monitor warfarin therapy is referred to as the INR or international normalized ratio. This test can be performed by finger stick or venous stick depending on the laboratory procedures. Essentially, this ratio is determined by measuring the patients prothrombin time, a test of blood thinness. This value is divided by the lab standard normal value. For patients with a pulmonary embolism, the warfarin dosing will be titrated so that the INR value will be 2.0 – 3.0, basically the blood needs to be 2 to 3 times thinner than the normal value. It is very helpful for the patient to participate in their health management by keeping a diary of their warfarin dose, the date of testing, and their INR values.

Medically Reviewed by a Doctor on 6/30/2014

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