In principle, the following measures are available for the acute therapy of pulmonary embolism:
- Anticoagulation (anticoagulation; NOAK: apixaban, dabigatran, edoxaban, and rivaroxaban) or intravenous thrombolysis (dissolving the thrombus) as an emergency measure in case of hemodynamic deterioration (ESC guideline: class 1 recommendation).
- Recanalizing procedures (reopening of displaced vessels): thrombectomy (surgical removal of a blood clot (thrombus) from a blood vessel) (ESC guideline: class 2a recommendation).
In any case, secondary prophylaxis with vitamin K antagonists such as phenprocoumon is required.
Depending on the severity of pulmonary embolism, the following therapeutic regimens can be distinguished:
- Anticoagulation alone (anticoagulation).
- Systemic thrombolysis or anticoagulation alone.
- Systemic thrombolysis, recanalizing procedures or surgery if necessary.
- Systemic thrombolysis, if necessary recanalizing procedures or surgery (time!!).
In severity 3 or 4, the following recanalizing procedures are used:
- Catheter-based thrombus fragmentation – comminution of the thrombus using catheter procedures.
- Embolectomy/plumonalisthrombectomy – surgical removal of the embolus from the opened vessel.
- Pulmonary endarterectomy – removal of the embolus in patients who develop chronic thromboembolic pulmonary hypertension (“pulmonary hypertension”).
