A pulmonary embolism (PE) is not physically “removed” in most cases. The standard treatment is blood-thinning medication that stops the clot from growing while your body dissolves it naturally over weeks to months. Only when a PE is large enough to destabilize your heart or drop your blood pressure do doctors escalate to procedures that actively break up or extract the clot. The approach depends entirely on how severe the blockage is and how your body is responding to it.
How Doctors Decide Which Treatment You Need
When you arrive at a hospital with a confirmed PE, the medical team classifies it by risk level. They use a scoring system called the Pulmonary Embolism Severity Index, which factors in your age, heart rate, blood pressure, oxygen levels, and whether you have other conditions like cancer, heart failure, or chronic lung disease. The score places you into one of five risk classes, from very low to very high.
Low-risk patients may not even need an overnight hospital stay. Intermediate-risk patients typically need close monitoring and possibly more aggressive intervention. High-risk patients, meaning those whose blood pressure has dropped dangerously or whose heart is struggling to pump, need urgent clot removal through one of several methods.
Blood Thinners: The Primary Treatment
Anticoagulation, or blood-thinning medication, is the foundation of PE treatment for the vast majority of patients. These drugs don’t dissolve the clot directly. Instead, they prevent new clots from forming and stop the existing one from getting bigger, giving your body’s own clot-dissolving systems time to do the work.
Treatment typically starts immediately. If you can take pills, your doctor will likely prescribe a direct oral anticoagulant, which is preferred over older blood thinners because it’s easier to manage and causes less bleeding. The first week or few weeks involve a higher dose to get things under control, then the dose drops for ongoing maintenance. If you need an injectable blood thinner first, low-molecular-weight heparin is the go-to because it carries fewer complications than the older intravenous form.
The initial treatment phase lasts 3 to 6 months. After that, your doctor reassesses. If your PE was triggered by something temporary, like surgery or a long flight, you may be able to stop. If there’s no clear trigger or if you have an ongoing risk factor, guidelines now recommend continuing blood thinners indefinitely to prevent the clot from coming back.
Clot-Dissolving Drugs for Severe Cases
When a PE is life-threatening, meaning your blood pressure is crashing or your heart’s right side is failing under the strain, doctors may use powerful clot-dissolving medications called thrombolytics. These drugs actively break apart the clot rather than waiting for your body to do it, and they work fast.
The trade-off is a significant bleeding risk. In clinical trials, about 9% of patients who received systemic thrombolytics experienced major bleeding outside the brain, and roughly 2% had bleeding inside the brain. Outside of controlled trial settings, the brain bleeding rate climbs to 3% to 5%. Because of this, thrombolytics are reserved for patients who are hemodynamically unstable, where the risk of dying from the clot outweighs the risk of a serious bleed.
Several conditions make thrombolytics too dangerous to use at all: a history of bleeding in the brain, recent brain or spinal surgery, active bleeding anywhere in the body, or a stroke within the past three months. For patients who fit these profiles, mechanical removal becomes the next option.
Catheter-Based Clot Removal
Over the past decade, catheter-based mechanical thrombectomy has become a major option for patients with intermediate or high-risk PE. These procedures involve threading a catheter through a vein, usually in the leg, up into the pulmonary arteries where the clot sits. The device then physically suctions or pulls the clot out.
Two devices dominate this space. The FlowTriever system uses large-bore aspiration and a mechanical disk to capture and extract clot material. In a registry of 800 patients across 50 U.S. sites, it reduced pressure in the pulmonary arteries from an average of 33 to 25 mmHg immediately after the procedure. The major complication rate was 1.8%, and 48-hour mortality was just 0.3%. Improvements in heart function and breathlessness held steady at 6 months. In a separate study of 63 high-risk patients, there were zero deaths at 48 hours.
The Indigo aspiration system takes a similar approach, using continuous suction to pull clot from the arteries. In a study of 119 patients, it significantly improved the ratio of right-to-left heart size (a key marker of strain on the heart), with a major complication rate of 1.7% at 48 hours.
These catheter procedures are appealing because they remove the clot without the systemic bleeding risk of thrombolytics. They’re performed by interventional radiologists or cardiologists, typically under sedation rather than general anesthesia, and patients generally recover faster than those who undergo open surgery.
Open Surgery to Remove the Clot
Surgical pulmonary embolectomy is the most invasive option and is reserved for the most dire situations. It’s open-heart surgery: the surgeon opens the chest, places the patient on a heart-lung bypass machine, and manually extracts the clot from the pulmonary arteries.
This procedure is indicated when other options have failed or aren’t possible. Specifically, it’s considered for patients in deep shock from a massive PE when thrombolytics are contraindicated, when thrombolytic therapy or catheter procedures have already been tried and failed, or when the patient is already on emergency mechanical circulatory support due to cardiac arrest. It’s also the preferred route for patients who develop a massive PE within two months of brain or spinal surgery, since clot-dissolving drugs could cause catastrophic rebleeding at the surgical site. Patients with large clots in the main pulmonary arteries or with a rare condition called paradoxical embolism (where a clot crosses through a hole in the heart) are also surgical candidates.
Surgical embolectomy carries the highest risk of any PE treatment, but for patients who are actively dying from a massive clot, it can be lifesaving when nothing else will work fast enough.
IVC Filters: Preventing the Next Clot
An inferior vena cava (IVC) filter doesn’t remove a PE. It’s a small metal device placed in the large vein that carries blood from your lower body to your heart, designed to catch future clots before they reach your lungs. It’s used when you have a documented clot but absolutely cannot take blood thinners, whether due to active bleeding, a recent hemorrhage, or a severe reaction to anticoagulants. It’s also placed when blood thinners have failed and you’ve developed a new PE despite being on medication.
If the reason you can’t take blood thinners is temporary, a retrievable filter is placed and removed once you can safely restart anticoagulation. If the contraindication is permanent, a non-retrievable filter stays in place for life.
What Recovery Looks Like
Hospital stays vary widely. Some low-risk PE patients go home the same day or the next. Those who undergo catheter-based removal typically stay a few days. Surgical embolectomy requires a longer intensive care and hospital stay, as with any open-heart procedure.
Most people start feeling noticeably better within a week of starting treatment. But full resolution takes much longer. The clot itself can take months or even years to completely dissolve, and some patients have lingering issues with right heart function months after the event. Fatigue and reduced exercise tolerance are common during recovery even after the acute danger has passed.
Long-Term Risk: Chronic Pulmonary Hypertension
In a small but meaningful percentage of PE survivors, the clot never fully resolves. Instead, it organizes into scar tissue inside the pulmonary arteries, permanently raising blood pressure in the lungs. This condition, called chronic thromboembolic pulmonary hypertension, develops in about 2.3% of PE patients within three years. It causes progressive shortness of breath, exercise intolerance, and, if untreated, right heart failure.
Diagnosis requires specialized imaging of the lung blood vessels and a procedure to directly measure pressures inside the heart. Because symptoms develop gradually and overlap with general deconditioning after a PE, it’s often missed. If you find that your breathing isn’t improving or is getting worse months after a PE, that’s worth raising with your doctor, as early detection makes a significant difference in treatment options.