Pulmonary Embolism and Pulmonary Hypertension

It is important to assess the right ventricle of the heart of PH patients

A recent reader of PulmonaryHypertensionRN.com wrote in with an excellent question that I suspect is on many patients minds.  Pulmonary embolism (a blood clot in your lung) is a very common medical problem.  Occasionally this can lead to pulmonary hypertension in a few percent of patients.  The larger the blood clot the greater the likelihood that if you had an echocardiogram shortly after the event you would have signs of mild pulmonary hypertension.  What is the appropriate management and follow up?

Blood Thinners for Pulmonary Embolism

The majority of patients with pulmonary embolism can be managed with blood thinners such as Heparin, Lovenox, Xarelto, Eliquis or Warfarin.  Over time, blood thinners prevent further blood clots and allow your body to dissolve the existing blood clot.  More than 95% of patients will do very well with blood thinners and their symptoms should resolve within a few weeks to a couple of months.  By three months, the majority of patients have had maximal resolution of their blood clots.

The duration of anticoagulation (use of blood thinners) depends on the circumstances surrounding your blood clot. Was it provoked? Or was it unprovoked by external circumstances such as surgery, trauma or hospitalization?

In patients that had evidence of elevated pulmonary artery pressure by echocardiography, we would favor repeating an echo about 3 months after the initial event.  This time interval allows your body to dissolve the blood clot with help from blood thinners.  If you have ongoing evidence of pulmonary hypertension at the three-month mark, you should see a specialist with expertise in the evaluation and management of pulmonary hypertension.  If your echocardiogram is reassuring, no further testing is required.