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Parenteral Antithrombotics: Pulmonary Embolism - #MEDSHED

Updated: Apr 6

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🚨 Parenteral Antithrombotics: Pulmonary Embolism - #MEDSHED

📢 One of the most important things to keep in mind when treating pulmonary embolisms are categorizing the severity. Massive and submassive PEs are associated with acute hemodynamically instability requiring vasopressor support. These patients have a high risk of decompensating and require immediate thrombolysis. Our agent would be alteplase, which binds to fibrin, coverting plasminogen to plasmin, resulting in clot breakdown. For massive PE not in cardiac arrest, general dosing recommendations are 100 mg IV over 2 hours. Patients actively in cardiac arrest require 50 mg IVP over 2 minutes PRN x 2 doses.

💉 Enoxaparin, low-molecular weight heparin, is more reserved for non-massive PEs and those hemodynamically stable. Dosing is 1 mg/kg subq every 12 hours or 1.5 mg/kg subq every 24 hours. Activity is specific to Anti-Xa. Caution with renal impairment as enoxaparin is renally metabolized (consider alternative CrCl < 30).

💥 Unfractionated heparin is also reserved for non-massive PEs and those hemodynamically stable. Also, given its short half life of 1 to 2 hours, it may be more appealing if thrombectomy are still options. Dosing is 80 units/kg as an IV bolus, then 18 units/kg/hr.


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