Monday, May 7, 2012

Treatment of Pulmonary embolism

1. Anticoagulation: Heparin + Warfarin. Stop Heparin after 5-7 days when Warfarin may've kicked in. Target is INR of 2-3

2. IVC filter:
if heparin is contraindicated
if recurrent embolic event even while on heparin or therapeutic Warfarin (INR 2-3)
if there's severe disease with right ventricular dysfxn and enlargement. The next embolus could be fatal so put a filter

3. Thrombolytics (t-PA- tissue plasminogen activator): if patient is too unstable or if there's RV dysfxn

Aspirin is useless in PE

Note: watch out for HITT with heparin therapy. - monitor cbc
Patient on heparin
5-10 days after start of treatment
New thrombus or expansion of old one
Mgt: stop heparin, give thrombin inhibitor: Argatroban or lepirudin

Do not transfuse platelets in HITT

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