What is your protocol for transitioning to oral anticoagulation post thrombolysis for pulmonary embolism?

High risk PE's are typically treated with loading doses of anticoagulants or bridging with LMWH. Do you omit the bridging/loading period and go straight to maintenance anticoagulation to reduce the chance of hemorrhage in patients post thrombolysis? Does this differ between systemic and catheter directed thrombolysis?

Answer from: at Community Practice

My answer has multiple parts. "Thrombolysis" is not all the same. Studied in stroke treatment, alteplase causes marked fibrinogen depletion and coagulopathy (prolonged PT, aPTT) whereas tenecteplase doesn't so much (https://doi.org/10.1161/STROKEAHA.115.011290). So if alteplase was used (systemic ...

Comments

Medical Oncologist at Atlantic Health System/Morristown Medical Center
Can you expound a little on how you define normali...

at Washington State University Floyd College of Medicine
Good questions. I'm an internal medicine pulmonary...

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What is your protocol for transitioning to oral anticoagulation post thrombolysis for pulmonary embolism?

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