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Pulmonary embolism (TELA) - Prevention

Alexey Kryvenko, medical expert
Last reviewed: 04.07.2025

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Prevention of PE consists of timely extension of bed rest in the postoperative period, diagnosis and treatment of thrombophlebitis of the veins of the lower extremities.

For patients with heart failure, obesity, malignant neoplasms, operations on the pelvic organs and retroperitoneal space, after hip alloprosthetics, in order to prevent phlebothrombosis of the lower extremities and pulmonary embolism, it is recommended to administer heparin subcutaneously 5 thousand IU 2 times a day, starting from the evening before surgery until the end of the period of greatest risk of phlebothrombosis (7-10 days).

In recent years, the use of low molecular weight heparins has been proposed for the prevention of phlebothrombosis.

Low molecular weight heparin preparations contain a fraction with a molecular weight of 3000-9000 Daltons and have a relatively high inhibition activity against factor Xa. This leads to a more pronounced antithrombotic effect. At the same time, low molecular weight heparin preparations inactivate thrombin very slightly, have a lesser effect on vascular permeability and cause thrombocytopenia less often than conventional unfractionated heparin, which causes a significantly lower risk of bleeding.

Recommended doses of low molecular weight heparins for the prevention of deep vein thrombosis:

enoxaparin (clexane, lovenox) - 40 mg (or 4000 IU) 1 time per day or 30 mg (3000 IU) 2 times per day;
fraxiparin (nadroparin) - 0.3 ml (or 3075 ME) for 3 days, and from the 4th day 0.4 ml (or 4100 ME) 1 time per day;
dalteparin (fragmin) - 5000 IU 1 time per day or 2500 IU 2 times per day;
reviparin (clivarin) - 0.25-0.5 ml (or 1750-3500 ME) 1 time per day.

The use of heparin reduces the risk of non-fatal PE by 40%, fatal PE by 60%, and deep vein thrombosis by 30%.

In recent years, a method of surgical prevention of PE has become widespread using the implantation of an umbrella filter into the infrarenal section of the inferior vena cava. This operation is indicated:

in case of embologenic thrombosis of the ileocaval segment, when it is impossible to perform embolectomy;
in case of repeated embolism into the pulmonary artery system in patients with an unknown source of embolism;
in case of massive pulmonary embolism.

Umbrella filters ("embolus traps") are placed in the infrarenal portion of the vena cava by percutaneous puncture of the jugular or femoral vein.

All patients who have had PE should be monitored for at least 6 months to ensure timely detection of chronic pulmonary hypertension, which develops in 1-2% of cases due to mechanical obstruction of blood flow in the pulmonary circulation.