What is your protocol for transitioning to oral anticoagulation post-thrombolysis for pulmonary embolism?
High-risk PEs are typically treated with loading doses of anticoagulants or bridging with LMWH. Do you omit the bridging/loading period and go straight to maintenance anticoagulation to reduce the chance of hemorrhage in patients post-thrombolysis? Does this differ between systemic and catheter-directed thrombolysis?
1 Answer
Mednet Member
Pulmonology · Washington State University Floyd College of Medicine
Answered on
My answer has multiple parts.
"Thrombolysis" is not all the same. As studied in stroke treatment, alteplase causes marked fibrinogen depletion and coagulopathy (prolonged PT, aPTT), whereas tenecteplase doesn't so much (Huang et al., PMID 26514192).
So, if alteplase was used (systemic or reduced cathe...
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