What Is the Life Expectancy After Pulmonary Embolism?

Pulmonary embolism (PE) is a serious condition that can affect life expectancy. It impacts about 900,000 people in the United States each year and is one of the leading causes of cardiovascular death.

Pulmonary Embolism and Life Expectancy

Pulmonary embolism (PE) is a potentially life-threatening condition with variable effects on life expectancy. It affects around 900,000 people in the United States every year and remains one of the most common causes of cardiovascular death.

PE, along with deep vein thrombosis (DVT)  is classified as a venous thromboembolic (VTE) disease. These diseases are characterized by the abnormal formation of blood clots, known as thrombi.

In DVT, a blood clot forms in a deep vein, often in the thigh or lower leg. If the clot breaks loose, it can travel through the blood vessels and settle in a lung artery, forming a pulmonary embolus. This is how most PE cases occur.

Over 70% of PEs are asymptomatic and dissolve on their own without causing harm. However, acute PE, which causes symptoms, can have severe consequences.

Acute PE is thought to affect around 10% of patients with DVT, of whom 10% will die suddenly while in hospital.

Left untreated, acute PE is associated with a mortality (death) rate of as high as 30%. Of those who received timely treatment, the mortality rate is around 8%.

Factors Affecting Survival

Life expectancy after a pulmonary embolism is often evaluated using five-year mortality rates. These rates indicate the percentage of people who may die within five years of their diagnosis.

Life expectancy following PE is influenced by a number of factors, not least of which is the type of PE you experience. There are several categories of this.

Among them:

• Provoked PE occurs when the condition is caused (provoked) by DVT. In cases like this, the five-year mortality rate is roughly 20%.
• Unprovoked PE, also known as idiopathic PE, is when the cause of the clot is unknown. These tend to be less severe with a five-year mortality rate of around 15%.

The severity of the PE event can also influence survival times. These are broadly categorized as follows:

• Low-risk PE, also known as non-massive PE, is an uncommon condition affecting the left ventricle of the heart (which pumps blood to the body), causing left heart strain. This is associated with a five-year mortality rate of 12%.
• Intermediate-risk PE, also known as sub-massive PE, affects the right ventricle of the heart (which pumps deoxygenated blood to the lungs), causing right heart strain. This is associated with a five-year mortality rate of up to 23%.
• High-risk PE, also known as massive PE, is when the right ventricle is severely affected, causing hemodynamic instability (characterized by a massive drop in blood pressure and increased risk of shock). In this instance, the five-year mortality rate may be as high as 44%.

The severity of PE can also be seen in the 90-day mortality rates:

• Low-risk PE has a 90-day mortality rate of less than 2%.
• Intermediate-risk PE has a 90-day mortality rate of 15%.
• High-risk PE has a 90-day mortality rate of 58%.

What this suggests is that the majority of deaths from immediate- and high-risk PE will occur within 90 days of the acute event.

What Long-Term Challenges Can Arise After a PE?

Surviving a PE isn’t the end. Long-term complications may cause symptoms years later, and the risk of another blood clot increases.

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 that causes ongoing shortness of breath and results from elevated pressure in lung arteries due to 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 PE may be at higher risk of another blood clot and another PE event. This is true particularly if your PE was unprovoked.

The same may be true if PE was caused by an underlying clotting disorder like thrombophilia (which causes platelets to clump together) or cancers associated with abnormal blood clot formation (like acute leukemia and certain types of brain cancer).

In some cases, lifelong anticoagulants (blood thinners) may be prescribed to avoid this.

What Influences Recovery After a PE?

Recovery after PE depends on factors such as underlying health conditions and the cause of blood clots. Understanding what to expect can aid you in coping and setting steps for a successful recovery. 

The following factors can affect recovery time:

• The size of the blood clot
• The severity and location of arterial obstruction
• Older age (as recovery tends to be slower in older adults)
• Underlying medical conditions (like heart failure, lung disease, smoking, or cancer)
• Your baseline health before acute PE

Steps to Take During PE Recovery

If you are diagnosed with PE, you may be monitored in the hospital for a few days and be placed on anticoagulants for at least three months to prevent the clot from getting bigger as your body naturally breaks it down.

For those who can’t take blood thinners, an IVC filter may be placed in the inferior vena cava. This device “catches” clots that may break free, preventing them from reaching the lungs.

If the embolus is very large or causing significant strain on the heart, your healthcare team may recommend an embolectomy to surgically remove the clot or thrombolysis to help dissolve the clot with intravenous (IV) drugs.

Recovery at Home

Once home, you would continue taking blood thinners as long as your healthcare provider tells you. Follow-up appointments involving pulmonary function tests (PFTs) and heart and lung imaging are commonly scheduled to keep track of your condition.

During recovery, it is important to keep moving to prevent the enlargement of an existing clot or the formation of new ones. Your healthcare provider will work with you to devise an exercise program that may involve regular walking, swimming, or a stationary bicycle.

Recovery times from PE can vary. However, symptoms tend to improve after several days of anticoagulant therapy. Complete recovery may be expected within several weeks or months, depending on the size and location of the clot.

However, around 15% of people will develop a longer-lasting condition called post-thrombotic syndrome due to the formation of scar tissue at the site of the clot. This can cause chronic pain ranging from mild to severe, which may eventually ease or persist over the long term.

Living With PE and Ongoing Treatment

You must address any underlying causes of blood clotting. Depending on the cause of the PE, you may be advised to remain on lifelong anticoagulant therapy.

As opposed to common blood thinners like warfarin, PE is typically treated with anticoagulants like:

• Xarelto (rivaroxaban)
• Lixiana (edoxaban)
• Eliquis (apixaban)

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.