INVESTIGATIONS & DIAGNOSIS, TREATMENT PLAN

INVESTIGATIONS & DIAGNOSIS

– Wells score assessment
– Score >4: likely PE
– Score <4: unlikely PE

TREATMENT PLAN 

• If Wells >4: direct admission for CTPA, if scan not immediately available, then start on interim therapeutic anticoagulants
• If haemodynamically unstable/pregnant/postpartum: immediate

admission

• If Wells <4: D-dimer +/- CTPA (depending on the D-dimer result) – Anticoagulation options:
• Baseline bloods: FBC, U&Es, PT, APTT (can start treatment without waiting for           results)
• Apixaban 10mg BD 7 days, then 5 mg BD for 3 months/Rivaroxaban 15mg BD 21                  days, then 20mg OD for 3 months
• Dabigatran/Edoxaban (after 5 days of LMWH)
• Warfarin: in combination with LMWH for at least five days until the INR is two on      at least two readings, then can continue warfarin on its own for three months (10 mg              for the first two days and then 3-9 mg for the rest of the duration) – Mechanical interventions:  – IVC filter
• Stent placement
• Thrombolysis