: Roughly 70% to 80% of emboli arise from proximal deep veins in the legs or pelvis.
: Once a clot lodges in the pulmonary vascular bed, it increases pulmonary vascular resistance, which can lead to acute right ventricular (RV) failure and hemodynamic collapse.
: Computed Tomographic Pulmonary Angiography ( CTPA ) is the gold standard for confirmation. Ventilation-perfusion ( Download Embolie pulmonaire aiguГ« pdf
) scans are alternatives for patients with renal issues or contrast allergies. Management and Treatment
: The mainstay for most patients. Low-molecular-weight heparin (LMWH) is often preferred over unfractionated heparin (UFH) for initial treatment. Long-term management typically involves Direct Oral Anticoagulants (DOACs) like apixaban or rivaroxaban. : Roughly 70% to 80% of emboli arise
Patients with a first episode of unprovoked PE usually require anticoagulation for at least 3 to 6 months. Extended therapy may be necessary if persistent risk factors exist. Long-term monitoring is essential to detect rare complications like , which can present as persistent breathlessness months after the initial event.
: D-dimer testing is highly sensitive for ruling out PE in low-to-intermediate risk patients. Cardiac biomarkers like Troponin and BNP help assess myocardial injury and RV strain. : For high-risk (hemodynamically unstable) patients
: For high-risk (hemodynamically unstable) patients, systemic thrombolysis (e.g., Alteplase) is recommended to rapidly dissolve the clot.