A patient diagnosed with a pulmonary embolism continues to have hypoxia despite receiving therapeutic anticoagulation. What could be the possible explanation, and what should be the next steps?
If a patient continues to have hypoxia despite anticoagulation for a pulmonary embolism, it's possible that the patient might have a large burden of clot that is not quickly resolving, or there could be a recurrent PE despite anticoagulation. Other possibilities include complications such as a pulmonary infarction or development of chronic thromboembolic pulmonary hypertension. Alternatively, another co-existing condition, such as pneumonia or heart failure, could be contributing to the hypoxia. The next steps would include reassessing the patient's condition, considering additional imaging such as a repeat CT scan or an echocardiogram to evaluate for right heart strain or pulmonary hypertension, and consultation with a specialist for potential escalation of therapy.