Pulmonary embolism: a review of medical treatment.

The use of heparin in pulmonary embolism is more complex than the average therapy manual might suggest. Pharmacokinetics and recent studies indicate that continuous IV infusion is the safest method of delivery and that doses should be individually tailored. Consideration of body weight, sex, renal or liver disease, and congestive heart failure should alter these doses. Patients at risk for hemorrhage require close PTT control and monitoring of Hgb or Hct. The fibrinolysins urokinase and streptokinase, although unavailable for general use, have been shown to be of benefit especially in massive pulmonary embolism. At present massive pulmonary embolism is treated with larger doses of heparin and/or inferior vena cava interruption. Persistent hypotension is ominous and must be corrected.