Pulmonary Embolism

Question 1

What is a PE?

Answer 1

Blood clot which forms in the pulmonary arteries

Usually the result of a DVT

Collectively known as VTE

Question 2

Risk factors for PE (9)

Answer 2

Immobility
Recent surgery
Long haul flights
Pregnancy
Hormone therapy with oestrogen
Malignancy
Polycythaemia
Systemic lupus erythematosus
Thrombophilia

Question 3

Presentation of PE (8)

Answer 3

SOB
Cough with or without blood (haemoptysis)
Pleuritic chest pain
Hypoxia
Tachycardia
Raised respiratory rate
Low grade fever
Haemodynamic instability causing hypotension

Unilateral leg swelling and tenderness

Question 4

What is the Wells score?

Answer 4

Predicts risk of a patient presenting with symptoms actually having a DVT or pulmonary embolism

<4 PE unlikely -d-dimer, if +ve perform CTPA
>4 PE likely perform CTPA

Question 5

Two options for definitive diagnosis in PE

Answer 5

CTPA

Ventilation-perfusion scan

Question 6

What is the immediate management of a PE?

Answer 6

Apixiban or Rivaroxiban

LMWH (enoxaparin or dalteparin where DOAC not suitable)

Question 7

Long term management of PE

Answer 7

Long term coagulation:
Warfarin
DOAC
LMWH (first line in pregnancy or cancer)

Target INR on warfarin is 2-3

Question 8

How long to continue anticoagulation?

Answer 8

3 months - if there is obvious reversible cause
3 moths+ if cause unclear, recurrent VTE or irreversible underlying cause(thrombophilia)
6 months - active cancer

Question 9

When is thrombolysis appropriate?

Answer 9

Massive PE with haemodynamic compromise

EG. Streptokinase, alteplase, tenecteplase

Iv peripherally or central catheter