Pulmonary Embolism (cont.)
Thrombolytic therapy
Pulmonary embolism can be fatal, especially if involves a large amount of
clot. When the patient is unconscious, has low
or no blood pressure or are not breathing, clot busting or thrombolytic therapy
using medications like TPA (tissue plasminogen activator) may be considered. It
is also often considered when signs of right heart strain are present. Some
physicians argue that thrombolytic therapy should be used more often, since the
source clot is also dissolved as well as the pulmonary embolus. This therapy is
associated with a slightly greater risk of bleeding and is contraindicated if
recent surgery or significant trauma has occurred.
What is the prognosis for pulmonary embolism?
Patient survival depends upon:
- the underlying health of the patient,
- size of
the pulmonary embolus,
- the cause of the pulmonary embolus, and
- the ability for a diagnosis to be made and
treatment initiated.
The diagnosis is often difficult, and it is estimated to that there are up to
400,000 cases of pulmonary embolus that are not diagnosed in the United States
each year.
In those patients where the diagnosis is made, the mortality rate is less
than 20% when considering all patients. Usually, however, the mortality risk is
much less in most patients. The higher incidence of death occurs in patients
that are older, have other underlying illnesses, or have a delay in diagnosis.
Racial differences may also exist, but probably are due more to access to
quality care than a specific genetic difference.
How can pulmonary embolism be prevented?
As mentioned earlier, minimizing the risk of deep vein thrombosis is key in
preventing a potentially lethal illness.
- In the hospital setting, the staff works hard to minimize the potential for
clot formation in immobilized patients. Compression stockings are routinely
used. Surgery patients are out of bed walking (ambulatory) earlier and low dose
heparin or enoxaparin is being used for deep vein thrombosis prophylaxis
(measures taken to prevent deep vein thrombosis).
- For those who travel, it is recommended that they get up and walk every
couple of hours during a long trip.
- Compression stockings may be helpful in preventing future deep vein thrombus
formation in patients with a previous history of a clot.
Next: Pulmonary Embolism At A Glance »
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