Therapy of pulmonary embolism

The therapy depends mainly on the stage. At each stage, therapeutic hepar administration is necessary. Heparin is administered via a so-called perfusor in a constant dosage via a venous access.

From stage II to IV, a so-called thrombolytic therapy (taking into account contraindications, e.g. not after recent operations) can be performed. Thrombolytics actively dissolve the thrombosis or pulmonary embolism. For this purpose, drugs such as: are given.

A major risk of this therapy is that the patient has a significant tendency to bleed during the therapy. From stage III to IV a so-called catheter fragmentation can be performed. This method is only available in selected centers.

A catheter is inserted directly into the pulmonary embolism via the blood vessel (artery) and then mechanically shredded. From stage IV and absolute danger to life, an attempt can be made to surgically remove the pulmonary embolism. In general, pulmonary embolism is followed by permanent coagulation therapy with Marcumar.

Marcumar inhibits the coagulation system, which increases the time it takes for the blood to coagulate. This reduces the risk of thrombosis.

Streptokinase
Urokinase
Rt-PA (tissue plasminogen activator)

If acute signs of a pulmonary embolism occur, immediate first aid measures are necessary to ensure that the person affected has a chance of survival.

Often, conscious patients are extremely agitated, so they should first be calmed. Due to the sudden lack of oxygen and its effect on the heart, the person should move and strain himself as little as possible. It usually helps to put the person down.

However, the upper body should be raised a little. It is important to talk to the affected person and find a comfortable position. If the person is unconscious, breathing and pulse must be checked regularly.

In the event of a circulatory arrest, resuscitation (resuscitation) must be started immediately. This consists of alternating 30 cardiac pressure massages and 2 breathing sessions. It is important not to forget to call the emergency doctor (112) during the excitement.

The emergency doctor can treat the clot using heparin (blood thinner). In addition, it is usually necessary to administer oxygen and painkillers. Further treatment must normally take place in hospital.

Lysis (more precisely “fibrinolysis” or “thrombolysis”) for pulmonary embolism is usually performed on patients who are in an unstable circulatory state. This can be seen, for example, in blood pressure, heart rate and the amount of oxygen in the blood. Its aim is to actively dissolve the clot and thus open the occluded vessel as quickly as possible.

For this purpose, various drugs can be injected into a vein of the patient. Lysis always carries the risk of triggering a severe bleeding. For example, it should not be carried out if a major operation has recently taken place or there has been a cerebral hemorrhage.

The 2010 guidelines state that the Wells Score should be determined at the very beginning of any suspected case of pulmonary embolism to assess the level of risk. The taking of blood values and the determination of vital parameters such as blood pressure, pulse and temperature are always included as basic diagnostics. In the further course of the procedure, an image is taken in a spiral CT scan.

In the next step, a ventilation scintigraphy and a perfusion scintigraphy can be performed to confirm or exclude a possible suspicion. According to the guidelines, an MR angiography can also be performed, although the validity of this is not completely proven. An echocardiography (heart ultrasound), an ECG and sonography (ultrasound) of the deep veins of the leg can complete the diagnosis.

The guidelines recommend anticoagulation after pulmonary embolism for 3 – 6 months. Depending on the cause of the embolism, anticoagulation can also be performed for an unlimited period of time. If a pulmonary embolism is diagnosed, Marcumar is generally used in Germany to thin the blood, also known as anticoagulation.

How long anticoagulation is necessary depends on the cause of the pulmonary embolism. If a cause can be clearly identified that was only temporary – for example, a long journey, immobility after surgery or a temporary, serious illness – Marcumar can usually be discontinued after 3 months. If pulmonary embolism occurs in known cases of cancer, Marcumar should be given for life or at least until healing.

If no cause can be determined, the further procedure depends on whether there was a leg vein thrombosis at the time of the pulmonary embolism. In the case of leg vein thrombosis in the hip or thigh close to the body, anticoagulation should be administered for life. In the case of leg vein thromboses in the lower leg that are far from the source of the disease, anticoagulation can be terminated after 3 months. If pulmonary embolisms or leg vein thromboses occur repeatedly without a cause being identified, it is also recommended that Marcumar be taken for life. Factors such as previous illnesses and the risk of bleeding are also included in the final decision on the duration of anticoagulation – which is why the duration of anticoagulation is ultimately a case-by-case decision by the treating physician.