Pulmonary embolism

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(Redirected from PE)

Definition

  • Embolism involving the pulmonary arteries, most often thromboembolism, though other etiologies are possible

Classification

  • Massive PE, defined by having all of:
    • Hypotension, with SBP <90 OR a decrease of 40 for at least 15 minutes; and
    • Requiring pressors; and
    • Not explained by another cause
  • Submassive PE: RV dysfunction or troponins/BNP elevated
  • Low risk: no RV dysfunction, no hypotension or shock, troponins/BNP normal

Prognosis

  • Low risk: mortality <1%
  • Sub-massive: mortallity 6-12%
  • Massive: mortality 55-70%

Management

CrCl BMI Enoxaparin Dalteparin Tinzaparin Unfractionated Heparin
≥30 <40 1 mg/kg SC q12h, or

1.5 mg/kg SC q24h

200 units/kg SC q24h, or

100 units/kg SC q12h

175 units/kg SC q24h IV bolus, with continusuous infusion to titrate to anti-Xa 0.3 to 0.7 IU/mL (or corresponding aPTT)
≥40 1 mg/kg SC q12h 100 units/kg SC q12h
<30 Any Aoivd Avoid Avoid