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Treatment of a medium sized pulmonary embolus

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Consult expert help:

  • sit the patient up (unless there is severe shock)
  • administer oxygen, up to 100%
  • administer morphine 10 mg i.v., especially if patient in pain
  • start heparin
    • low molecular weight heparin is as effective as unfractionated heparin (1)
  • give patient thrombo embolism deterrent stockings to wear
  • patients have and require high right heart filling pressures; treatment with diuretics and vasodilators is deleterious
  • once stabilised on heparin, commence warfarin treatment; give loading dose of 10 mg daily for two days; adjust third daily dose according to the patient's INR. Aim to maintain the INR at 2.5-3.5X normal. In general, treatment with warfarin is for 6 months for a first PE (1)

Reference:

  1. Robinson GV. Pulmonary embolism in hospital practice. BMJ 2006; 332: 156-60.

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