My Dad has a blood clot smack in the middle of his pulmonary?!

My Dad has a blood clot smack in the middle of his pulmonary?

artery and he has had it for 12 days before being seen by a Doctor, he is extremely stubborn and refused to go to the ER, being that he weighs 350# the doctors dont want to do any surgeries or procedures thinking he end up with a stroke or other complications, so they are going to send him home with Coumadin and major pain meds d/t severe pain, does this mean he will be a ticking time bomb. the doctors say he cantt get any worse and the clot isnt going any where and in fact they said it is already in the worse spot that it could be in.. What is the prognosis of this and is he pretty much a ticking time bomb, Thanks for any input! the pain is d/t ischemia from the blood clot laying where it is.

The coumadin is one of several treatment options available to your father. Treatment depends on the size and severity of the embolus. Current treatments include anticoagulant ('blood thinner') and oxygen therapy, thrombolysis, or a vena cava filter. If surgery is required, procedures include traditional pulmonary embolectomy or catheter-directed pulmonary embolectomy.

Patients with stable acute pulmonary embolism are usually hospitalized immediately so that a blood thinning agent (anticoagulant) can be given and oxygen administered. Anticoagulants prevent further traveling of a blood clot and reduce the threat of another embolus. The most widely used intravenous anticoagulant is heparin. This drug acts quickly and can stop blood-clot formation almost immediately.

In addition to heparin (in your father's case), patients are treated with warfarin (coumadin). This pill acts more slowly and in a different way from heparin. Warfarin takes about five days to take effect so intravenous heparin is given until warfarin can take effect.

Thrombolysis or reperfusion therapy involves injecting a thrombolytic (clot-dissolving) agent into the pulmonary artery to dissolve the blood clot and restore blood flow. Unlike heparin, thrombolytic agents can dissolve an existing clot in both the deep venous system and the pulmonary circulation.

If the patient cannot tolerate the anticoagulant therapy or has other conditions that might lead to excessive bleeding, a filter device can be introduced through a catheter and positioned within the vena cava (the large vein leading to the heart) to trap large clots before they reach the pulmonary circulation.

Pulmonary embolectomy (surgical removal of the emboli) may be useful for unstable pulmonary emboli when other treatments fail. Catheter-directed pulmonary embolectomy involves inserting a catheter via the femoral or internal jugular vein and using fluoroscopic guidance to navigate into the pulmonary artery. Emboli are then extracted from the pulmonary bed using a cup device and syringe suction.

I wonder why a physician would send your father home if the blood clot is still present. I know his weight is a concern, but if the clot were to move into the lung, he could end up in serious trouble and not be in the hospital where he belongs. Perhaps it would be a good idea to consult with his physician and ask why these other methods were not used. As you can see, the "surgery" is actually performed with catheterization which carries some risk of a stroke. However, to leave a blood clot in the artery and allow him to go home doesn't make much sense either. I am not a physician, but I believe I would ask for a second opinion from another specialist before it is too late. Good luck to you and your father.