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Is chronic anticoagulation always given after pulmonary embolism?

What are the risks or disadvantages

  • if anticoagulation is not given?
  • if terminated early?
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1 Answer 1

Not always, however typically it is given for at least a few months. Lack of anticoagulation therapy would greatly heighten the risk of having another PE or related cardiovascular events. At the worst side this could cause death or permanent disability, and PE related deaths are quite common. However this depends on the nature of the PE and risk factors. For example, obesity, cancer and the pill are all risk factors and if these were reduced then it is likely the person wouldn't have another PE despite not being on long term anticoagulation therapy. However, if there is an underlying cause even despite anticoagulation therapy a person may suffer a PE.

The problem with anticoagulation therapy is of course it stops your blood clotting. Thus haemorrhages are more common and also more severe. However in an individual receiving anticoagulation therapy, they typically have increased clotting so this may be balanced out by therapy.

Finally anticoagulation therapy is typically warfarin in the long term. Warfarin interacts with so many drugs including even antibiotics, it is teratogenic and quite sensitive to diet (any changes in Vitamin K will directly affect the effectivity of warfarin) thus frequent monitoring is required. This is annoying for the patient as they have to report for frequent blood tests as well as watch their diet etc.

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It should be noted that the teratogenicity should not be too great of an issue as those trying to conceive can be switched to low molecular weight heparin –  Rory M May 17 '13 at 17:41
    
I summarize that specifically addresses my questions: Anticoagulation is typically given. Not giving anticoagulation risks another PE or related cardiovascular events, in the worst (not rare) case leading to death or permanent disability. -- Would the second PE be somehow triggered by the first one? Or by the same factors triggering the first one? –  winerd May 28 '13 at 21:17
    
The latter, same triggers –  AndroidPenguin May 29 '13 at 20:24
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