CLINICAL MANAGEMENT GUIDELINE

Acute massive pulmonary embolism

ICD10: Pulmonary embolism without acute cor pulmonale [I26.9]

Treatment: Thrombolytics for PE with systolic BP <90 mm Hg

Massive PE is defined as a systolic blood pressure < 90 mm Hg or a drop in systolic arterial pressure of at least 40 mmHg for at least 15 minutes or hypotension that requires vasopressors or inotropic support and is not explained by other causes.


Exclude thrombolytic contraindications:

Absolute contraindications:1

  • Haemorrhagic stroke or stroke of unknown origin at any time
  • Ischaemic stroke in the preceding 6 months
  • Central nervous system damage or neoplasms
  • Recent major trauma/surgery/head injury (in the preceding 3 weeks)
  • Gastrointestinal bleeding within the last month
  • Known bleeding risk.

Relative contraindications:

-Transient ischaemic attack in the preceding 6 months -Oral anticoagulant therapy -Pregnancy or within 1 week postnatally -Traumatic resuscitation (in relation to this episode of PE) -Refractory hypertension (SBP >180 mmHg) -Advanced liver disease -Infective endocarditis -Active peptic ulcer.

Treatments

Level 1 / 2
pharmacological
alteplase
ROUTE
IV
DOSE
100.000 mg
FREQUENCY
STAT over 2 hrs
consultation
Referral to clinical hematologist

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