Treating acute pulmonary embolism with anticoagulant therapy (Guideline) - PulmCCM
Apr 092012

The content previously here was removed at the request of the American College of Chest Physicians.

For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website.

PulmCCM is not affiliated with ACCP or Chest.

Liked this post? Get a weekly email update, and explore our library of clinical guidelines, practice updatesreview articles. and board review questions.

PulmCCM is an independent publication not affiliated with or endorsed by any other organization, society or journal referenced on the website. (Terms of Use)

Authors: contribute your work in a guest post.

  7 Responses to “Treating acute pulmonary embolism with anticoagulant therapy (Guideline)”

  1. The above statements regarding lovenox dosing appear to suggest we use a 2 mg/kg once a day dose versus the APPROVED dose of 1.5 mg/kg once a day. The CHEST guidelines reference APPROVED dosing of LMWH where the total once a day dose is equivalent to the bid total daily dose. Unfortunately, this language may cause over dosing errors with once a day lovenox. Lovenox 2mg/kg once daily has never been studied in RCTs and should not be advocated (per the manufacturer clinical experts).

    • Mike: Thanks for making this very important point. I revised that section of the post (above) to draw attention to this question and I’ve also emailed Elie Akl, the corresponding author to ask for clarification. -Matt

  2. Is there ever any differentiation between LMWH and IV unfractionated heparin? A common regional practice is to use IV UFH for “large” pulmonary clots. Am I correct that this distinction is not made in the guidelines and, if anything, LMWH is actually preferred unless the patient may be a thrombolytic candidate?

  3. Is there any evidence to treat with subcutaneus unfractionated heparin for acute PE?

  4. can anyone clarify the following?

    1) When is unfractionated Heparin preferred over LMWH ?

    2) What is the difference of efficacy in Unfractionated Heparin and LMWH in Massive PE? Any clinical trial comparing this?

  5. What happens if there is a patient with previous dvt or pe that is being treated with coumadin. They have been therapeutic but become subtherapeutic. Is it necessary to bridge these patients?

  6. No I dont think so , I had a patient who had no access whatso ever and we decided to give him big doses of S/Q UFH and recheck PTT in 2-3 hrs after the dose and then come up with a dosing protocol for that , never were able to figure out what is the correct dose for that, he died from CRI and ESRD complications