Life Expectancy and Recovery After Pulmonary Embolism

Pulmonary embolism (PE) is a potentially life-threatening situation in which a blood clot becomes lodged in the blood vessels of the lungs. It can block blood flow to the lungs, leading to low oxygen levels, rapid heart rate, and in some cases, death.

Survival after PE depends on several factors, including age, underlying medical conditions, and the size of the clot. After PE, mortality can range from 5–15% but may be higher or lower depending on the circumstances. Read on to learn more about factors affecting life expectancy and recovery after a PE.

Does a Pulmonary Embolism Reduce Life Expectancy?

PE is a potentially life-threatening situation with variable effects on life expectancy. A large clot in the pulmonary arteries may strain the heart, lower oxygen levels, and ultimately lead to cardiovascular collapse and death. This is referred to as a massive PE.

However, not all PEs are large or significant enough to even cause any symptoms. These PEs are considered low risk, and some PEs are even found incidentally on imaging performed for other reasons.

PEs can be categorized in different ways, and management varies based on the following types:

• Provoked PE: A PE that has an identifiable risk factor, such as surgery, trauma, pregnancy, or hormonal contraception.
• Unprovoked PE: A PE in which no risk factor is identified.
• Massive PE: A PE causing low blood pressure and elevated heart rate.
• Sub-massive PE: A PE causing a strain on the heart, which may be identified on imaging tests and/or with labs.
• Low-risk PE: A PE without any effect on blood pressure or heart rate and without signs of heart strain
  

Survival Rate

In some studies, short-term (or 30-day) mortality rates with PE are as high as 18%. However, mortality rates vary based on multiple factors. Clinical scores have been developed to provide a prognosis and guide the management of PE. These incorporate underlying risk factors, vital signs, and certain markers present at the time of diagnosis.

The Pulmonary Embolism Severity Index (PESI) is one such score that provides an estimate of 30-day mortality based on the following:

• Age and sex
• History of medical conditions like heart failure, cancer, and underlying lung disease
• Vital signs (blood pressure, heart rate, respiratory rate, and temperature)
• Oxygen saturation
• Altered mentation, such as the presence of confusion or coma

Long-Term Symptoms and Complications

Unfortunately, surviving a PE isn't the end of the story. Long-term complications can cause symptoms even years after a PE is diagnosed. Additionally, the risk of repeat blood clots may increase.

Pulmonary Infarction

When blood flow to the lungs is blocked by a PE, the lung tissue can die of starvation, from lack of oxygen and nutrients. This is known as pulmonary infarction. When a large enough portion of lung tissue is permanently damaged, shortness of breath and exercise intolerance can result. Supplemental oxygen may be necessary in some cases.

CTEPH

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of PE that can cause chronic shortness of breath. CTEPH is a form of pulmonary hypertension, in which the pressure in the lung arteries is elevated due to blood clots and scarring.

Surgery is the preferred treatment for CTEPH for those who are candidates. It is also managed via medication if a person isn't eligible for surgery. Lung transplant is for those who are not candidates for or who have failed surgery or medical treatments.

Recurrent Blood Clots

People who have experienced a PE may be at higher risk of another blood clot. The risk depends on the reason for the first blood clot. If cancer or an underlying blood clotting disorder is present, for example, the risk is higher. In some cases, lifelong blood thinning medication may be recommended.

Factors That Affect Recovery Time

Recovery after PE varies based on factors like underlying medical conditions and the reason for the blood clots in the lung. Knowing what to expect can help with coping during recovery and set you up for the best chance of success. The following factors can affect recovery time:

• Size of blood clot (massive, sub-massive, or low-risk)
• Age
• Underlying medical conditions, like heart failure, lung disease, smoking, or cancer
• Baseline health status
  

What to Expect During Recovery

If you are diagnosed with a PE, you may be monitored in the hospital for a few days and start taking a blood-thinning medication called an anticoagulant. In addition to blood thinners, you may need supplemental oxygen and pain medications temporarily. If the PE is very large or causing significant strain on the heart, your healthcare team may recommend a procedure to remove the clot (embolectomy) or deliver medication to break up the clot (thrombolysis).

For those who can not take blood-thinning medications, the placement of a device called an IVC filter may be recommended. IVC filters prevent other clots from the leg or pelvic veins from traveling up to the lungs and causing more problems.

When you are home from the hospital, you should continue the prescribed blood thinning medication without missing any doses. This medication doesn't break up the clot directly but helps prevent the clot from getting bigger while your body breaks down the clot over months. Normally, blood thinners are required for at least three months, often longer. Your healthcare team can help determine when or if it is safe to discontinue blood thinners.

It's important to note that you may experience some physical deconditioning after PE. This may be related to the damage to the lungs themselves, but even the immobilization of staying in the hospital can quickly lead to weakness and fatigue.

Returning to exercise under your healthcare provider's guidance may involve slowly getting back to exercise, starting with recumbent activity like a stationary bicycle and working your way up to your previous activity levels. It's important to keep as active as possible because immobility is a risk factor for blood clots.

Lastly, age-appropriate cancer screening should be performed, particularly in unprovoked PE patients. And your healthcare team may recommend follow-up testing with lung imaging, heart imaging, and/or pulmonary function testing.

Ongoing Treatment at a Glance

You must address any underlying causes of blood clotting. Depending on the cause of the PE, you may be advised to remain on lifelong blood-thinning medication. These medications have a risk of bleeding, so it's important to discuss this risk with your healthcare provider and avoid any activities with a risk of head injury, such as contact sports.

Summary

The prognosis after a PE varies widely based on many factors. Age, underlying health conditions, and blood clot size are some predictors of mortality. Blood thinners are a cornerstone of therapy, and are typically recommended for at least three months, and sometimes indefinitely. Recovery can take weeks to months, though there are some complications that can lead to long-lasting symptoms. It's important to take medication as prescribed and stay as active as possible to prevent further blood clots.

A Word From Verywell

Experiencing a PE can be an extremely frightening experience, from the symptoms of shortness of breath, chest pain, and anxiety to hospitalization and various medical testing. Know that it is normal for recovery to take time, and your healthcare team will work with you on a treatment plan.