Duration of the therapy
Depending on the extent to which pulmonary vessels are blocked by the clot, the affected patients have severe or less severe symptoms. In most cases, however, pulmonary embolism is accompanied by acute shortness of breath and requires inpatient therapy. Depending on the various risk factors, hospital treatment with anticoagulants is usually initiated and should usually be continued for three to six months in order to prevent recurrences.
Acute treatment in hospital usually lasts one to two weeks, provided no further complications occur. An important reason for in-patient treatment is the monitoring of cardiac function, which is necessary in most cases, since pulmonary embolism usually causes an acute additional burden on the right heart. However, imaging procedures and laboratory tests can usually only be performed in an inpatient setting.
Therapy of a pulmonary embolism in pregnancy
Due to numerous hormonal changes in the body of an expectant mother, pregnancy is in principle already associated with an increased risk of developing a pulmonary embolism. Depending on the source, a three- to fourfold increase in risk is indicated. The diagnosis of pulmonary embolism in a pregnant patient is difficult because the unborn child should not be exposed to radiation, but CT is usually the gold standard.
In pregnant women, ultrasound imaging of the deep veins of the legs, the most common site of thrombus formation, is therefore often used. When anticoagulation is used, it should be ensured that it is maintained for the entire duration of the pregnancy and for at least three months. Low molecular weight heparins such as Clexane® are the agents of choice here.
These can be administered without any problems even during pregnancy. Alternatively, Fondaparinux, a synthetic heparin, can be given. Marcumar® is inherently contraindicated and should only be used under strict indication and if other therapy options fail.
Absolutely contraindicated in pregnancy are new oral direct anticoagulants such as Xarelto®. These should not be used in pregnant patients. If possible, lysis therapy should not be used either, as this significantly increases the risk of bleeding for the mother and the unborn child and can lead to serious complications. Interventional procedures using catheters to re-open the affected vessel should be preferred in this case.
