Pulmonary Embolism | A Life-Threatening Condition

As a professional pharmacist, it’s critical to shed light on Pulmonary Embolism (PE), a serious condition that can be life-threatening if not promptly treated.

What is Pulmonary Embolism?

PE occurs when a blood clot travels to the lungs, blocking one or more pulmonary arteries. This blockage can severely impair lung function and reduce oxygen levels in the blood.

Symptoms:

Sudden shortness of breath
Chest pain (may worsen with deep breaths)
Rapid heart rate
Cough (may produce blood)
Dizziness or fainting

Drug of Choice:

Heparin (initial treatment) followed by Warfarin or Direct Oral Anticoagulants (DOACs) like Rivaroxaban

Mechanism:

Heparin prevents clot formation by inhibiting thrombin and Factor Xa. Warfarin inhibits vitamin K-dependent clotting factors, while DOACs directly inhibit specific clotting factors.

Dosage:

Heparin:

Adults: Initial IV bolus of 80 units/kg, then continuous infusion of 18 units/kg/hour
Children: Individualized dosing based on weight and clinical condition

Warfarin:

Adults: Typically 2-10 mg daily, adjusted based on INR (International Normalized Ratio)
Children: Dosing is highly individualized and requires close monitoring

Rivaroxaban:

Adults: Initial dose of 15 mg twice daily for 21 days, followed by 20 mg once daily
Children: Dosing varies based on weight and age, requiring specialist supervision

Side Effects:

Bleeding
Bruising
Gastrointestinal discomfort
Heparin-induced thrombocytopenia (HIT) with heparin
Elevated liver enzymes (with DOACs)

Drug Interactions:

Increased bleeding risk with other anticoagulants, antiplatelets, and NSAIDs
Warfarin has numerous interactions, including with antibiotics, antifungals, and certain foods (e.g., vitamin K-rich foods)

Contraindications:

Active bleeding
Severe uncontrolled hypertension
Recent surgery or trauma
Known hypersensitivity to the medication

Patient Counseling:

Monitor for signs of bleeding (e.g., unusual bruising, blood in urine/stools) and report immediately
Regular blood tests (INR for warfarin) are crucial to ensure safe and effective dosing
Avoid activities that increase the risk of injury
Inform all healthcare providers about anticoagulant use before any medical or dental procedures
Adhere strictly to prescribed dosages and schedules

Disclaimer:

This information is intended for educational purposes and should not replace professional medical advice. Always consult with a healthcare provider for medical conditions and treatments.