Medications for pulmonary embolism may decrease the size of blood clots, help dissolve them, or reduce the risk of recurrence. All of these medications carry the risk of bleeding.

A pulmonary embolism (PE) is a type of venous thromboembolism that causes blood clots to form in your lungs. These usually begin in another part of your body, such as your legs, and then travel to your pulmonary arteries.

The exact treatment for PE depends on its severity and whether you need critical treatment in an emergency room setting. PE medications are usually considered before medical procedures.

Learn more about medications for PE, including the types, goals, and risk factors.

Medications for PE fall into two categories: blood thinners (anticoagulants) and clot-dissolvers (thrombolytics).

These two classes of medications serve completely different purposes.

Anticoagulants are used to prevent new and future cases of blood clots that can lead to PE. They may also reduce the size of a blood clot in your lungs. A doctor might prescribe them for both purposes.

Thrombolytics, on the other hand, break up existing blood clots as an emergency therapy. As such, these medications are not taken on a regular basis.

Treatment for PE may reduce the risk of serious complications, such as:

Anticoagulants are first-line medications for treating venous thromboembolism, including PE and deep vein thrombosis (DVT). As their name suggests, these prescription medications prevent coagulation or blood clots.

A doctor may prescribe anticoagulants for PE for a few different reasons. First, if you have DVT, you may be at risk of developing PE if a blood clot breaks off and travels to your lungs. These medications may reduce the size of the blood clot and prevent future ones from forming.

How long do you need to take blood thinners?

Anticoagulants may be prescribed for 3 months or longer. Some people need these blood thinners for life. The exact timeline depends on the severity of PE, as well as your individual response to the medication.

What are the potential side effects of blood thinners?

Despite their wide use and effectiveness, anticoagulants pose the risk of severe and sudden bleeding. These risks may also be increased if you take other blood thinning medications or supplements.

Possible signs and symptoms of bleeding from anticoagulants include:

  • gums that bleed easily
  • frequent nose bleeds
  • easy bruising
  • cuts and other injuries that don’t stop bleeding
  • heavier menstrual periods
  • blood in urine or stool
  • vomiting or coughing up blood
  • dizziness
  • general weakness

How are blood thinners given?

While most prescription anticoagulants are oral medications, a doctor may sometimes administer them intravenously or through injections.

Oral anticoagulants fall into two categories: conventional blood thinners and direct oral anticoagulants (DOACs). Conventional versions include heparin and warfarin (Coumadin).

DOACs are a newer class of anticoagulants that carry fewer risks and restrictions than conventional versions. These include the following options:

  • apixaban (Eliquis)
  • betrixaban (Bevyxxa)
  • dabigatran (Pradaxa)
  • edoxaban (Lixiana, Savaysa)
  • rivaroxaban (Xarelto)

While anticoagulants are primarily used for decreasing blood clot size and occurrence in PE, thrombolytics may be needed in emergency situations. These work by dissolving the blood clot in your lungs.

How long do you need to be on clot-dissolving medications and how are they given?

Due to their action and risk for side effects, thrombolytics are exclusively used for PE in emergency situations.

Also, unlike anticoagulants, thrombolytics are administered intravenously through an IV at the hospital. They aren’t prescribed on a long-term basis.

What are the potential side effects of clot-dissolving medications?

Alteplase (Activase) is the most common thrombolytic medication used to treat PE. While it carries a low risk of allergic reactions compared with other thrombolytics, the medication is associated with the risk of bleeding. However, the lifesaving benefits may outweigh such risks.

To dissolve a blood clot in PE, an emergency room doctor may provide alteplase via an IV in a 100 mg dose within a 2-hour timeframe.

Medications for PE are considered first-line treatments for this condition. However, they may not be appropriate for all cases.

If a doctor doesn’t believe you are a candidate for anticoagulants, or if your condition doesn’t respond to these blood thinning agents, they may recommend a vena cava filter placement. It’s inserted into your vena cava, the largest vein in your body.

The purpose of a vena cava filter device is to help capture blood clots before they get to your lungs. However, it cannot break up any existing blood clots from PE.

Alternatively, if you have a large blood clot or are experiencing a related medical emergency due to PE, a doctor may perform a thrombectomy or embolectomy to remove it.

This procedure, also called catheter-assisted blood clot removal, involves inserting a catheter into your veins to help break up a blood clot in emergency situations.

Medications for PE come in the form of either anticoagulants or thrombolytics.

While anticoagulants are more preventive medications, they can also help decrease the size of a current blood clot. Thrombolytics, on the other hand, are emergency treatments for large blood clots that may be blocking your arteries. This includes a PE.

Despite their lifesaving properties, both types of PE medications may pose the risk of serious bleeding. If you’re prescribed anticoagulants, it’s important to take your medication as prescribed and to tell your doctor about any other vitamins, supplements, or medications you take.

If you require emergency medical treatment for PE, the benefits of thrombolytics may outweigh the risk of bleeding.