Children's Community Nursing Service, Richmond
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.
About 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 that starts elsewhere in the body. The clot has broken off and travelled to the arteries in the lung.
A PE is a serious condition because it can prevent blood from reaching your lungs. Prompt medical treatment can be lifesaving.
Symptoms
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 PEs develop from clots in the leg.
Causes
There are lots of things that might cause a PE, including:
- 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).
Treatment
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 medium or high risk, you will be admitted to hospital for treatment. 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.
Blood thinning medicines
Blood thinning medicines (also called 'anticoagulants') are the most common treatment for a clot. These reduce your body’s ability to form clots.
In clinic, we will explain blood thinning medication to you. This will include 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),
- dabigatran
- 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.
Bleeding risk
Blood thinning medicines reduce clotting and so increase your risk of bleeding.
You will be given an anticoagulation alert card to carry at all times. This tells emergency services and health professionals that you are at risk of bleeding.
- unexpected or uncontrollable bleeding
- a fall or injury to your head
- coughing or vomiting blood
- blood in your urine
- black stools or blood in your stools
- severe unexplained bruising
- a severe headache that will not go away and/or dizziness or weakness.
Going home
Prescriptions
When you 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. If it is agreed in clinic that you need further prescriptions, you will get these from 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.
Further tests
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.
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.
Returning to work
You may feel able to return to work within a few weeks. This will depend on the severity of your symptoms and the nature of your work. You can discuss this with your GP or practice nurse.
Air travel
You should not fly for at least 2 weeks, or longer if you are not feeling well. If you need to fly, speak to your GP first. They may provide compression stockings to wear during a flight.
Taking other medicines
Avoid certain medicines
There are certain medicines that you can buy without a prescription that can increase your risk of bleeding. While you are taking blood-thinning medicines, you should not take:
- non-steroidal anti-inflammatories, such as ibuprofen, naproxen and diclofenac.
Painkillers that you can take
If you need to take painkillers for any reason, you may take:
- paracetamol, codeine, co-dydramol or co-codamol.
Reducing the risk of another clot
Your risk of another clot
Everyone’s risk of another clot is different. Taking anticoagulants as they are prescribed should prevent you from having a further PE.
If we decide to stop your anticoagulation 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.
Reducing the risk
To reduce your risk of developing another PE, 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. The less time you are immobile the better. 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 clotting, especially during a long journey or after surgery.
Physical activity
You should avoid strenuous exercise. However, you should try to carry out your normal daily activities, including walking, if you feel able to.
Staying in bed 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.
More information
The following websites have more information on pulmonary embolism.
Contact information
Telephone:
Anticoagulation Helpline
020 8934 2030
Same Day Emergency Care Unit
020 8934 3651
020 8934 3883