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 |
