John Bielinski, MS PA-C 
Case Study: Acute PE in a 61 y/o Male
A 61 y/o male admitted for upper gastrointestinal bleeding from peptic ulcer disease complains of acute onset of shortness of breath and was found to have a saddle right lung PE by CT.
What is the most appropriate treatment?
- Pulmonary embolectomy
- Oral anticoagulation
- Thrombolytics
- IV Heparin (bolus the drip)
- Inferior vena cava filter
When CTA confirms an acute PE, anticoagulant is the key treatment. Almost always. What if the patient is super sick? Clinical presentation is severe enough to warrant thrombolysis. BUT… this is super rare. Really rare. I have never heard of it clinically.
A closer look
An inferior vena cava filter is an appropriate alternative for patients with confirmed acute PE who have a high risk for bleeding, complications of anticoagulation, recurrent PE despite therapeutic anticoagulation, or hemodynamic or respiratory compromise that is severe enough that another PE may be lethal. This is the answer my question was headed toward. BUT… I asked a bad question. So, we are going to accept embolectomy.
For patients with acute PE where thrombolysis is indicated, but who fail thrombolysis or have contraindications to thrombolysis, catheter or surgical embolectomy is suggested. BUT… this is rarer then thrombolysis. ICU stuff.
Conclusion
Students, it’s either anticoagulation (99%) or IVF filter (1%), in my clinical experience.
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