Immediate treatment consists of administration of oxygen in a high concentration and i.v. heparin. Digoxin is often useful. Sometimes it is necessary to use additional inotropic support for the circulation. Heparin is continued for 5-6 days. Oral anticoagulant therapy is started as soon as possible and is continued for at least 6 months.
Massive pulmonary embolus which does not respond to the above measures may warrant the use of thrombolytic agents, e.g.
streptokinase. The risk of haemorrhage with these agents is considerably higher than with heparin. If the cardiovascular effects of the embolism are life-threatening, open pulmonary embolectomy under cardiopulmonary bypass may be considered.
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