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Review
. 2024 May 16;20(3):27-35.
doi: 10.14797/mdcvj.1338. eCollection 2024.

Anticoagulation Management Post Pulmonary Embolism

Joseph J Naoum  1   2
Affiliations
Review

Anticoagulation Management Post Pulmonary Embolism

Joseph J Naoum. Methodist Debakey Cardiovasc J. .

Abstract

Pulmonary embolus (PE) carries a significant impending morbidity and mortality, especially in intermediate and high-risk patients, and the choice of initial anticoagulation that allows for therapeutic adjustment or manipulation is important. The preferred choice of anticoagulation management includes direct oral anticoagulants. Vitamin K antagonists and low-molecular-weight heparin are preferred in special populations or selected patients such as breastfeeding mothers, those with end-stage renal disease, or obese patients, among others. This article reviews the primary and longer-term considerations for anticoagulation management in patients with PE and highlights special patient populations and risk factor considerations.

Keywords: anticoagulation; deep vein thrombosis; direct oral anticoagulants; low molecular weight heparin; pulmonary embolus; revascularization; unfractionated heparin; venotonics; venous thromboembolism.

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Conflict of interest statement

The author has no competing interests to declare.

Figures

Algorithm of anticoagulation options for patients with PE
Figure 1
Algorithm summarizing the options of anticoagulation for patients with pulmonary embolism. PE: pulmonary embolism; DOAC: direct oral anticoagulant; LMWH: low-molecular-weight heparin; UFH: unfractionated heparin; VKA: vitamin K agonists; MPFF: micronized purified flavonoid fraction; ASA: acetylsalicylic acid * Full dose direct oral anticoagulants or reduced dose as per trials ** Usually at the reduced dose
See this image and copyright information in PMC

References

    1. Simon TG, Schneeweiss S, Singer D, Sreedhara SK, Lin KJ. Prescribing trends of oral anticoagulants in US patients with cirrhosis and nonvalvular atrial fibrillation. J Am Heart Assoc. 2023. Feb 7;12(3):e026863. doi: 10.1161/JAHA.122.026863 - DOI - PMC - PubMed
    1. Van der Wall S, Hendriks S, Huisman, Menno, Klok FA. Home treatment of acute pulmonary embolism: state of the art in 2018. Curr Opin Pulm Med. 2018. Sep;24(5):425–431. doi: 10.1097/MCP.0000000000000512 - DOI - PubMed
    1. Kuhrau S, Masic D, Manci E, et al. Impact of pulmonary embolism response team on anticoagulation prescribing patterns in patients with acute pulmonary embolism. J Pharm Pract. 2022. Feb;35(1):38–43. doi: 10.1177/0897190020940125 - DOI - PubMed
    1. Rivera-Lebron BN, Rali PM, Tapson VF. The PERT concept: a step-by-step approach to managing pulmonary embolism antithrombotic therapy for vte disease: second update of the CHEST guideline and expert panel report. Chest. 2021. Jan;159(1):347–355. doi: 10.1016/j.chest.2020.07.065 - DOI - PubMed
    1. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021. Dec;160(6): e545–e608. doi: 10.1016/j.chest.2021.07.055 - DOI - PubMed