Pulmonary Embolism (cont.)

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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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