6th July 2026

Pulmonary Embolism

As was previously explained, this occurs when a thrombus embolises and lodges into the pulmonary arterial tree. Common signs and symptoms of a PE include dyspnoea, chest pain – often pleuritic, and tachypnoea. In severe cases, patients may have hypotension and loss of consciousness. There may also be overlap with symptoms of a DVT. Investigation, similarly of note – a CTPA is not appropriate for certain patients – patients with allergies to contrast media, severe renal impairment (estimated creatinine clearance less than 30 mls/min), or high risk for irradiation. 

Investigation

Table 6- 2 Level PE Wells Score (adapted from: https://bmjopenquality.bmj.com/content/suppl/2015/12/08/bmjquality.u208698.w4222.DC1/ds6617.pdf)

Management

The treatment of a PE is largely the same as DVT – anticoagulation, taking into consideration the same contraindications, comorbidities, and patient preferences as stated previously. Treatment will be continued for at least 3 months. IVC filters and thrombolytic therapy are other candidates for treatment if anticoagulation is contraindicated or not tolerated. 

In the event that a patient is haemodynamically unstable, patients should be managed with a continuous unfractionated heparin infusion with a consideration for thrombolytic therapy. 

Indications for thrombolytic therapy are: 

• Patients with symptomatic iliofemoral DVT with symptoms lasting less than 14 days, 
• and good functional status  
• and life expectancy of at least 1 year 
• and low bleeding risk.  

Treatment should be started immediately and not be delayed by imaging or other investigations in the event massive PE is suspected.