Pulmonary Embolism (in Adults)


Major risk factors for PE


  • Major abdominal / pelvic / knee surgery
  • Post-op intensive care


  • Late pregnancy, Caesarian section
  • Puerperium

Lower limb problems

  • Fracture, Varicose veins


    • Abdominal / pelvic
    • Advanced / metastatic

Reduced mobility

    • Hospitalisation
    • Institutional care


    • Previous proven VTE

Management probable massive PE

Massive PE likely if:

  • Collapse/hypotension and
  • Unexplained hypoxia , and
  • Engorged neck veins , and
  • Right ventricular gallop (often)


Alteplase dose

For patients >65kg a total dose of 100mg should be administered in 2 hours as follows:
10mg as an IV bolus over 1-2 minutes, followed by an IV infusion of 90mg over 2 hours

For patients <65kg the total dose should not exceed 1.5mg/kg as follows:
10mg as an IV bolus over 1-2 minutes, followed by remainder of dose as an IV infusion over 2 hours

Post thrombolysis

  • Thrombolysis should be immediately followed by unfractionated heparin
    • Give bolus UFH 5000 units (unless earlier/on therapeutic LMWH)
    • Then 1000 U per hour and ajust to aPTT at 2.0-2.5 times the upper limit of normal
    • If already given LMWH, delay IV heparin for 12 hours and reassess (with aPTT)
  • Contraindications to thrombolysis should be reconsidered in life-threatening PE
  • Out -of-hospital cardiac arrest patients with PE rarely recover.
  • Thromboilysed cases should be discussed with the respiratory team on call.

Content by - Dr Íomhar O' Sullivan 22/09/2003. Based on the British Thoracic Society Guidelines 2003. Reviewed by Dr ÍOS 04/03/2007, 10/03/2009. Lasts review Dr √ćomhar O' Sullivan 8/04/21.