Pulmonary embolism: symptoms, treatment, Diane-35 pill, Nuvaring

Pulmonary embolism is the obstruction of blood flow to the lungs by one or more blood clots in an artery in the lungs. It is more common in the elderly and almost never in children. What can cause a pulmonary embolism, what are the symptoms and how is it treated? What does the Diane-35 pill have to do with pulmonary embolism? Why is the Nuvaring under fire?

Article content

  • Pulmonary embolism
  • Causes of pulmonary embolism
  • Symptoms of pulmonary embolism
  • Complications pulmonary embolism
  • Diagnosis pulmonary embolism
  • Treatment of pulmonary embolism
  • Pulmonary embolism prognosis
  • Diane-35 pill and pulmonary embolism
  • Nuvaring under fire (November 2013)
  • Lareb, the Dutch side effects centre

Pulmonary embolism

In a pulmonary embolism, a piece of clotted blood gets stuck in an artery in the lungs and blocks the blood supply to the affected area. Pulmonary embolism is more common in the elderly and rare in children. It is more common in some families. There are a number of risk factors that have to do with lifestyle (see the causes section).

Causes of pulmonary embolism

  • In most cases, the clot has broken off from a larger clot in the veins of the legs or pelvis (deep vein thrombosis) and traveled to the lungs.
  • The risk of pulmonary embolism is high in people with deep vein thrombosis as a result of a period of immobility . You should think of, for example, the period after childbirth, an operation (especially for hip fractures) or a long flight.
  • , smoking and oral contraceptives are also risk factors.
  • If you are predisposed to developing blood clots, this increases the risk of thrombosis in the deep veins.

Symptoms of pulmonary embolism

The symptoms depend on the extent to which blood flow is blocked. If a large clot blocks a major artery, it can cause sudden death. A single small clot sometimes has no consequences.

The following symptoms can often develop within a few minutes:

  • A tight feeling;
  • A sharp pain in the chest and the pain often becomes more severe with breathing;
  • Coughing up blood;
  • A feeling of weakness;
  • Palpitations.

Complications pulmonary embolism

  • If someone has had a pulmonary embolism before and it happens again, shortness of breath (which gets worse over the months) may be the only symptom.
  • If more and more blood vessels become blocked, the pressure in the veins of the lung increases: pulmonary hypertension . Chronic heart failure can then develop.

Diagnosis pulmonary embolism

If a pulmonary embolism is suspected, you will be rushed to hospital . The oxygen and carbon dioxide levels will be measured in the blood. An X-ray will be taken to rule out other diseases. The blood flow in the lungs can also be examined (pulmonary scintigraphy). Doppler ultrasound can be used to measure the blood flow in the veins of a leg. If the diagnosis is not clear, the spiral CT scan can provide clarity. It can also be checked whether there is a clotting disease.

Treatment of pulmonary embolism

Which treatment is chosen depends on the severity of the blockage .

  • An infusion or injection can be given with heparin, which is an anticoagulant. It prevents blood clots from getting bigger and new clots from developing. Nowadays, low molecular weight heparins are increasingly used. These are inserted into the skin daily with small syringes. At the same time, an oral anticoagulant, such as coumarin, can be given. This also prevents clots (it thins the blood), but only works after a few days.
  • If the embolism was caused by prolonged immobility, treatment with anticoagulants may last three to six months. If you have a long-term underlying condition, such as increased clotting ability of the blood, the person may always have to take medication. Blood clotting will then have to be monitored regularly and the dose will be adjusted if necessary.
  • If the situation is very serious, it may be necessary to dissolve the clot with thrombolytics.
  • If the main artery of the lungs is affected, surgery to remove the clot can save someone’s life.
  • If someone is receiving medication and clots still occur, a filter can be placed in the main artery through surgery. This filter catches clots that are transported from the lower body along the flow to the heart.

Pulmonary embolism prognosis

  • Pulmonary embolism is less serious if the blocked artery is small.
  • With a larger artery the consequences are serious and can be fatal . Severe pulmonary embolism is fatal in about a third of cases.
  • If someone survives the first three days, full recovery is possible.
  • Very occasionally, but that is really rare, a number of smaller arteries become blocked over the course of months or years. The symptoms then have an insidious course.
  • People with emboli that recur may remain short of breath. If you have had a pulmonary embolism you are more likely to have a recurrence, so avoid sitting still for a long time.

Diane-35 pill and pulmonary embolism

In the Netherlands, this pill may only be used to treat acne, mild excess hair and oily skin . However, the pill is also prescribed as a contraceptive. Doctors are advised not to prescribe the pill to new patients. As a user of the Diane-35 pill, you are approximately twice as likely to develop blood clots as users of other second-generation pills . Zembla (television program) has conducted research and it is possible that twenty-seven Dutch women have died due to side effects of Diane-35. That number is much higher than initially thought. Most women died of a pulmonary embolism. The majority of the victims were younger than thirty years old at the time of death.

Nuvaring under fire (November 2013)

  • After the Diane-35 pill, the Nuvaring is now also under international fire. In the United States, more than two thousand users and surviving relatives of users have filed a claim for damages. At least one death is said to have been reported. No deaths related to Nuvaring have been reported in the Netherlands, but 31 emboli (potentially fatal blood clots) have been reported. This is evident from data from Lareb, the Dutch side effects center.
  • More than seventy thousand women use Nuvaring, a vaginal contraceptive ring. The creator of the ring is the Brabant company MSD. It is a flexible ring that is worn in the vagina for three weeks in a row. The goal is to prevent pregnancy. The ring can only be obtained with a doctor’s prescription. Nuvaring contains the female sex hormones ethinylestradiol and etonogestrel. The ring releases a small amount of this into the blood every day, ovulation is inhibited and an egg is prevented from being released during the cycle

Lareb, the Dutch side effects centre

Every report of a side effect of a medicine or vaccine is carefully analyzed and ends up in one central collection point: the Lareb database. In this way, the safety of medicines and vaccines is monitored throughout the Netherlands. Lareb is also active in the field of safe drug use during pregnancy and breastfeeding (teratology). The teratology department advises healthcare providers about the treatment to be followed. Anyone can report side effects to Lareb, you will find a form on the website.