Pulmonary embolism

This leaflet is for patients who have been diagnosed with a Pulmonary Embolism (PE). It explains how a PE might affect you including the symptoms and treatments to expect.

What is a PE?

A PE happens when a blood vessel in your lungs becomes blocked. Most of the time this blockage is caused by a blood clot in the body that has broken off and travelled to the arteries in the lung. It is a serious condition because it can prevent blood from reaching your lungs. Prompt medical treatment can be lifesaving.

What are the symptoms of PE?

The symptoms of a PE are one or more of the following:

• chest pain and/or fast heart rate
• shortness of breath or difficulty in breathing
• coughing up blood
• feeling faint or passing out
• redness, swelling and pain in the leg (usually your calf) which might indicate a clot in the leg, as most PE’s develop from clots in the leg.

What are the causes?

• long periods of inactivity
• recent long-haul travel
• recent surgery
• previous blood clots
• cancer
• age
• obesity
• pregnancy and childbirth
• trauma including fracture
• certain types of oral contraceptive pill or hormone replacement therapy.

However, sometimes PEs occur for no obvious reason. Some people have an inherited or acquired tendency for their blood to clot. This is called Thrombophilia and can mean a PE is more likely to happen. It can also affect other members of the family. If this applies to you, you will be given advice about this and referred to the haematology clinic for support (haematology clinic is where we see patients who have a confirmed diagnosis of PE).

What is the treatment?

Blood thinners are the most common form of treatment. These reduce your body’s ability to form clots.

In clinic, we will explain blood thinning medication to you including how important it is to take the medication as prescribed to prevent the clot from getting any bigger and stop new clots forming.

Medication may be either injections or tablets. The most common choices are low molecular weight heparin (LMWH) injections, a direct oral anticoagulant (DOAC) (such as Apixaban, Rivaroxaban, or Edoxaban), or Dabigatran and Warfarin. Your doctor will discuss these options with you to decide which medicine is most suitable for you, taking account of any other health conditions that you have.

You will be given an anticoagulation alert card to carry at all times.

If you experience any of the following after starting your anticoagulants, please seek medical attention:

As part of your diagnosis of PE, you will have an assessment to check the risk of coming to harm from the PE. If you are thought to be at intermediate or high risk, you will be admitted to hospital and treated as an inpatient. If you are at lower risk, you will be treated as an outpatient.

If we decide to treat you as an outpatient, you will be reviewed by a senior clinician before you go home, but please contact your GP or return to your nearest Emergency Department (A&E) if you develop any new symptoms.

What happens after I go home?

You will be given a 1 month supply of medication and referred to the anticoagulation clinic for review. Within one month, they will contact you with an appointment date and time. The anticoagulation clinic will issue you a further 2 months’ supply of medication and, if it is agreed in clinic that you would benefit from further prescriptions, these will be provided by your GP. We will issue a DOAC (Direct Oral Anticoagulant) initiation form to your GP to inform them about the tablets they need to prescribe.

You may also be referred to the respiratory team for further hospital investigations if the doctor at the anticoagulation clinic feels this is required. This will be discussed with you in clinic.

Is there anything I can do to reduce the risk of developing another PE in the future?

Yes, keep as active as you can and lead as healthy a lifestyle as you can.

Keep yourself well hydrated and do not exceed the recommended limits for drinking alcohol.

Move your legs if you are not mobile for a long period of time (a general guideline is that the less time you are immobile the better, but try to move your legs at least every 4 hours). However, this will vary depending on individual risk factors. This can prevent blood from pooling in your legs and developing into a DVT (Deep Vein Thrombosis) or blood clot, especially during a long journey or after surgery.

What over the counter medications should I avoid?

• avoid taking non-steroidal anti-inflammatories such as Ibuprofen, Naproxen and Diclofenac
• consult your GP or usual healthcare professional for advice if you regularly take aspirin, whether prescribed by the GP or over the counter.

These can all increase your risk of bleeding.

If you are going to take any other medication, including herbal medicines, please make sure that the person providing them knows that you are taking anticoagulant medication. Multivitamins are generally safe.

What pain killers can I take if I have pain?

If you need to take painkillers for any reason, you may take paracetamol, codeine, co-dydramol, or co-codamol, but seek further medical advice if you have a chest pain that worsens despite taking these pain killers (this group of pain killers is known as analgesia).

When should I return to work?

Depending on the severity of your symptoms and the nature of your work, you may feel able to return to work within a few weeks. You can discuss this with your GP or practice nurse.

Will I have another scan?

Most patients will not have a repeat scan as the results do not usually change the way we manage your condition. However, if your PE was large or caused a strain to your heart, you may be asked to have a repeat scan. This will be explained to you before you go home or when you are seen in the hospital clinic.

When can I travel by air?

Air travel should be delayed for a minimum of 2 weeks or longer if you are not feeling well. If you need to fly, we advise you to speak to your GP about this. They may provide compression stockings to wear during a flight.

What is the risk of having another PE?

Everyone’s risk is different. Taking anti-coagulants as they are prescribed should prevent you from having a further PE.

If we decide to stop your anti-coagulation medication, we will review you in the haematology clinic. We will look at your case in detail and give you further advice to reduce the risk of another PE. This may include continuing anticoagulation medication if you are at high risk of having another PE or using anticoagulant medication in certain situations.

How much activity should I do?

• we advise you to avoid strenuous exercise, but try and carry out your normal daily activities including walking if you feel able to
• bed rest is not usually necessary
• while you are on an anticoagulation medication, you should avoid activities that will increase the risk of bleeding, such as contact sports.

Be guided by your body. If normal activity makes you feel short of breath or unwell, you will need to rest until you feel recovered. Once your symptoms have settled, you can start slowly increasing your activity.

Who shall I call if I have any questions relating to my anticoagulation medication?

If you have any questions, please contact the Anticoagulation Helpline (see Contacts below).

If you wish to speak to someone urgently, please contact the Same Day Emergency Care Unit (SDEC) (see Contacts below).

Where can I find further information regarding PE and blood clots?

Pulmonary Embolism https://cks.nice.org.uk/topics/pulmonary-embolism/
NHS.UK Blood Clots https://cks.nice.org.uk/topics/pulmonary-embolism/

Contacts

Anticoagulation Helpline	020 8934 2030
Same Day Emergency Care Unit	020 8934 3651 or 3883