Pulmonary Embolism in Lupus…. What is it??

Author: Sandy

Posted On: June 20, 2014

Recently I came across a lupie warrior with SLE and Pulmonary Embolism… And it stroke me, to throw some more light on to it. So that “FightSLE” can support all the strong lupie warriors around the globe. Hence, I asked my very supportive medical team to help me with this. And keeping my request they gave me a small idea which I am sharing below in my words.

Pulmonary Embolism... What is it? Who are at the high risk of it?

Pulmonary Embolism is regarded as blood clots in the pulmonary blood vessels in the lung. Generally, they are small in nature, but not dangerous. However, they damage the lungs. When they are blown up, they obstruct the blood flow to the lung and become fatal.

Individuals have Systemic Lupus Erythematosus are at a high risk of VTE or Venous thromboembolism. It is related to the disease activity. Those patients who have Antiphospholipid antibodies or aPL are open to increased risk which has climbed up to 35% to 42%. Two-thirds of the patients having lupus are prone to have those antibodies. Lupus anticoagulant (IgG) and anticardiolipin antibodies (IgM) are two major antibodies that constitute Antiphospholipid antibodies.

Those patients having Antiphospholipid Syndrome, along with VTE are in bigger threat of recurring abortions, Pulmonary Hypertension or PH, DAH, ARDS or Acute Respiratory Distress Syndrome, Cardiac Valvular Lesions.
VTE can be either acute in nature that is Deep Vein Thrombosis (DVT) or Acute Pulmonary Embolism (APE) or unceasingly, resulting in Chronic Thromboembolic Pulmonary Hypertension (CTEPH).

How to treat Pulmonary Embolism?

The best treatment of Pulmonary Embolism is prevention by minimizing the threat of the deadly illness of DVT. Firstly, it is important to understand whether the patient needs to be hospitalized or not.
Recent studies say, those pulmonary embolisms which are small and stable could be treated at home while patients with an unstable pulmonary embolism need to be hospitalized.

a. For home based treatments of the stable patients, the first step would be anticoagulation which includes immediate oral medication of Warfarin (a drug for anticoagulation) after the prognosis of pulmonary embolism. It may take a week to get the blood anti-coagulated. During this week, other mechanisms like Enoxaparin or Fondaparinux injections are administered to thin the blood till Warfarin becomes effectual.

It is suggested to continue the treatment of anticoagulation for at least six months. However, each patient needs to be individually studied for their complications and severity and treated accordingly. The Wafarin therapy is monitored through a blood test known an International normalized ratio or INR which is checking the thinness of the blood. During this therapy the blood needs to be 2 to 3 times thinner than the normal value that is the highly targeted INR is 2.0 to 3.0. A patient should monitor and maintain a diary of the Warfarin doses taken, dates of the blood tests and the INR values.

b. When the patient is having an outsized amount of blood clot, Pulmonary Embolism is taken as fatal. Using a medication like TPA or tissue plasminogen activator, Thrombolytic therapy is considered when the patient fails to breathe properly and loses his consciousness with less or no blood pressure. This therapy is also commonly termed as clot-busting. In some cases, catheter is placed on the right side of the heart to vacuum the clot out.

Compression stocking and mobilization are the two important factors that help in the prevention of Pulmonary Embolism. After all, prevention is better than cure.