Treatment of Pulmonary Embolism:

1. Bed rest for initial 24 to 48 hours recommended.

2. No robust data to suggest outpatient therapy for pulmonary emoblism.
3. Anticoagulation recommeded even before imaging, if suspicion is high.
4. Warfarin can be initiated on the first day.
5. Heparin or low molecular weight heparin should be continued for 5 days with warfarin overlap
for 2 days when INR becomes theraupetic.
6. Low molecular weight heparin merits over heparin: bioavailability, predictable dosing, lower
HIT
7. Anti Xa level recommeded only in wt > 150 kg or < 40 kg, renal insufficiency, or pregnany.
8. LMWH superior or as effective as unfractioned heparin in PE in reducing death and bleeding
complicaitons.
9. ACCP recommeds LMWH over heparin as IA in acute nonmassive pulmonary embolism.
10. LMWH over warfarin in cancer = lower thromboembolic complications.

Indications of a Venacaval filter:

1. CI to anticoagulation
2. recurrent embolism while on adequate therapy.
3. In case of massive PE when anticoagulation CI (no data)
4. Filters increase incidence of DVT and doesn't improve overall survival.

Indication of thrombolytic therapy:

1. Proven PE with cardiogenic shock. (no controversy)

2. Systemic hypotension without shock
3. Meta analysis of 11 trails showed no benefit of thrombolysis in submassive PE.