Pulmonary Embolus Clinical Suspicion
High Test results > 4h Intermediate Test results ≤ 24h Low AND
VKA x ≥ 5d and INR ≥ 2.0 x > 24h
LMWH daily or fondaparinux (or IV or subcut UFH)
x ≥ 5d and INR ≥ 2.0 x > 24h If contraindicated IVC filter
Anticoagulation if bleed risk resolves
3 months Surgical
1st high bleed risk or 2nd
Duration of Anticoagulation by Cause Extended
Transient Factor Unprovoked –
Unprovoked 1st
low-moderate bleed risk Cancer (LMWH preferred)
or 2nd Unprovoked –
Await test results
(SBP ≤ 90 mmHg) Hypotension
(2 h infusion via peripheral vein)
Thrombolysis
• Contraindications to thrombolysis • Failed thrombolysis • Shock – lethal within hours
Catheter-assisted thrombus removal
OR embolectomy Pulmonary
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