0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19
Pulmonary Embolism 1243➣Complications:
See unfractionated heparin; also
Follow anti-Xa activity levels if:
serum creatinine >2 mg/dl or calculated CrCl <30 ml/min)
Weight >100 or <45 kg
Pregnancy
➣Contraindications
See unfractionated heparin
■Thrombolytics
➣Indications: Documented PE with hemodynamic compromise
➣Complications:
Bleeding
Intracranial hemorrhage, 2%
Streptokinase: allergic reaction 1–4%, anaphylaxis 0.1%
➣Contraindications:
Absolute: Hemorrhagic stroke, intracranial tumor, AVM,
aneurysm, intracranial or intraspinal surgery or trauma, un-
controlled hypertension, internal bleeding, bleeding diathe-
sis
Relative: Surgery, prolonged CPR, puncture of non-
compressible vessel, hemorrhagic diabetic retinopathy,
severe liver or renal disease, endocarditis, pericarditis, pregna-
ncy, menstruation
■IVC filters
➣Indications:
lower extremity DVT+/or PE AND
Contraindication to anticoagulation, or
Recurrent PE despite anticoagulation, or
Compromised pulmonary vascular bed and residual DVT
➣Complications:
Thrombosis at insertion or filter site, IVC obstruction, erosion
through IVC
Short term decreased risk of recurrent PE partially offset by
higher long term risk of DVTs
Consider continuation of anti-coagulation
➣Contraindications
Will not prevent PE from RV or upper extremity
■Long-term therapy:
➣Warfarin
All should receive warfarin unless contraindication
Adjust dose to INR of 2.0–3.0