Clots that travels to lungs
DEAR DR. ROACH: A colleague of mine recently had a pulmonary embolus at age 45. She is otherwise healthy. What must she be concerned about?
ANSWER: A pulmonary embolus is a blood clot that travels to the lung. Although they can originate in any large vein, they most commonly come from the deep veins of the pelvis and thighs.
The clots can break off with or without physical activity, and they usually travel through the right side of the heart into the lungs.
The symptoms of PE include shortness of breath, chest discomfort, fast heart rate and cough. Some people experience a sense of impending doom; others have no symptoms at all.
Once the diagnosis is made (now mostly by CT scan, but nuclear and dye studies still are done sometimes), treatment is begun immediately with injection drugs to stabilize the clot and allow the body to dissolve it. (In very rare instances, drugs to dissolve the clot are given, with extreme caution.)
After four or so days on injection drugs, the person can be switched to oral medications, such as warfarin (Coumadin) or one of the new oral anticoagulant drugs.
The next issue for your colleague is determining why she got the PE, as that informs the decision about how long to continue anticoagulation.
The list of possible causes is too long to review here, but her doctors will look for hereditary causes of blood clotting, such as deficiencies in the coagulation factors protein C and protein S; they’ll evaluate her medications, if any, and perform a careful history and physical exam.
Undiagnosed cancer is a concern, and most authorities recommend appropriate screening — mammography, chest X-ray or other testing if indicated by the results of the initial evaluation.
The duration of anticoagulation depends, as I said, on the findings. If her clinicians cannot find a cause, many experts will give lifelong anticoagulation to people with a history of PE who also have a low risk of bleeding.
A hematologist is usually the expert on deciding duration of anticoagulation.
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