How Long Does It Take for a Saddle Pulmonary Embolism to Dissolve? 

Pulmonary embolism (PE) is a potentially life-threatening condition where a blood clot, typically formed in the deep veins of the legs (deep vein thrombosis or DVT), travels through the bloodstream and lodges in the pulmonary arteries of the lungs. When the clot is large and obstructs the main pulmonary artery or its major branches, also known as a saddle pulmonary embolism. The most common sign of saddle pulmonary embolism is shortness of breath. This situation can significantly impede blood flow to the lungs and is strenuous for the heart. 

In the face of such a critical medical condition, treatment is urgent. One of the primary treatment approaches is anticoagulant medications, also known as blood thinners, which work to dissolve the clot and prevent new ones from forming. However, a common question that arises is: “How long does it take for a saddle pulmonary embolism to dissolve?” In this comprehensive article, we will delve into the factors affecting clot dissolution, the role of anticoagulants, and the overall prognosis for patients with this condition. 

Understanding the Gravity of Saddle Pulmonary Embolism 

A saddle pulmonary embolism is characterized by the clot’s location—spanning the bifurcation of the main pulmonary artery into the left and right pulmonary arteries, resembling a saddle. This placement is particularly dangerous because it can obstruct blood flow to both lungs, impairing the body’s ability to receive oxygen. The severity of a saddle PE can vary based on factors such as the size of the clot, the patient’s overall health, and how quickly the condition is diagnosed and treated. 

Symptoms and Diagnosis 

Saddle PEs can manifest with a range of symptoms, some of which may include: 

Sudden and severe shortness of breath: Patients may experience rapid breathing and chest discomfort. 

Chest pain  

This can vary from a sharp, stabbing pain to a dull ache, often intensified by deep breaths or coughing. 

Rapid heart rate  

The heart may beat faster as it struggles to compensate for decreased oxygen levels. 

Coughing up blood  

Hemoptysis can occur when the clot damages small blood vessels in the lungs. 

Dizziness or fainting  

The brain does not receive enough oxygen. 

Prompt diagnosis is crucial. Physicians typically employ a combination of diagnostic tools, including medical history, physical examination, blood tests (such as D-dimer tests), and imaging studies like computed tomography pulmonary angiography (CTPA) or ventilation/perfusion (V/Q) scans. Once confirmed, immediate treatment is initiated. 

The Role of Anticoagulant Medications 

Anticoagulant medications play a central role in the management of saddle pulmonary embolism. These drugs are designed to inhibit the body’s natural blood-clotting mechanisms, ultimately preventing existing clots from growing larger and new ones from forming. The two primary classes of anticoagulants used are: 


Often administered initially as an intravenous (IV) medication in the hospital, heparin rapidly reduces the ability of the blood to clot. Once the patient is stable, it is usually followed by oral anticoagulants. 

Oral Anticoagulants:

These medications, including warfarin (Coumadin) and direct oral anticoagulants (DOACs) such as apixaban (Eliquis), rivaroxaban (Xarelto), and dabigatran (Pradaxa), are typically used for long-term anticoagulation. 

Timeline for Anticoagulation Therapy 

The timeline for anticoagulation therapy in the context of saddle pulmonary embolism can vary based on several factors: 

Clot Size:

Larger clots may take longer to dissolve completely, while smaller clots may resolve more quickly. 

Individual Response:

Response to anticoagulant therapy can differ from person to person. Some individuals may require more extended treatment than others. 

Underlying Health:

The patient’s overall health, including any underlying medical conditions, can influence the response to treatment. 

Treatment Adherence:

Consistency in taking prescribed medications is crucial. Missing doses or discontinuing treatment prematurely can impede clot dissolution. 

Typically, the acute phase of treatment in the hospital with intravenous heparin lasts for several days, during which the patient’s condition and response to treatment are closely monitored. Once the patient is stable, transitioning to oral anticoagulants for long-term management is common. The duration of oral anticoagulation therapy can vary, but it is often prescribed for a minimum of three months to prevent recurrent clots. 

The INR and Warfarin 

For patients on warfarin, the International Normalized Ratio (INR) is monitored regularly. The INR measures the time it takes for a patient’s blood to clot compared to a standardized sample. The target INR range for most patients on warfarin is usually between 2.0 and 3.0. This range ensures that the blood is anticoagulated enough to prevent clots but not so much that it leads to excessive bleeding. 

Adjusting warfarin dosages to maintain the desired INR range can sometimes be challenging and may require frequent monitoring and dose adjustments. Some patients may need to take warfarin for several months or even indefinitely, depending on their risk factors for recurrent clots. 

Factors Influencing Clot Dissolution 

Several factors can influence the rate at which a saddle pulmonary embolism dissolves: 

Clot Size:

As mentioned earlier, larger clots often take longer to dissolve fully. Smaller clots may be more quickly broken down by the body’s natural processes. 

Clot Composition:

The composition of the clot can impact its susceptibility to anticoagulant therapy. Clots primarily composed of fibrin and platelets are more responsive to treatment. 

Overall Health:

The patient’s overall health plays a significant role. A healthier individual with no underlying medical conditions may experience quicker clot dissolution. 

Treatment Adherence:

Consistently taking prescribed anticoagulant medications is crucial. Missing doses or discontinuing treatment prematurely can impede clot resolution. 

Response to Therapy:

Each patient responds differently to anticoagulant therapy. Some individuals may experience faster clot dissolution, while others may require more extended treatment. 

Recurrence Risk:

Patients with a higher risk of recurrent clots may need more extended treatment to prevent future episodes. 

Monitoring Progress 

Patients with saddle pulmonary embolism are closely monitored during treatment to assess progress and ensure their safety. Monitoring may include: 


Follow-up imaging studies, such as CTPA or V/Q scans, may be performed to track the size and location of the clot and assess its response to treatment. 

Clinical Assessment:

Physicians will continually evaluate the patient’s symptoms, vital signs, and overall condition to gauge improvement. 

Laboratory Tests:

Blood tests, including D-dimer levels and INR for patients on warfarin, are used to assess the effectiveness of anticoagulant therapy. 

Side Effects:

Monitoring for potential side effects of anticoagulant medications, such as bleeding complications, is essential. 

Complications and Risks 

While anticoagulant therapy is highly effective in treating saddle pulmonary embolism, it is not without risks. Some potential complications and considerations include: 


Anticoagulants can increase the risk of bleeding, which may range from minor nosebleeds to more severe gastrointestinal or intracranial bleeding. It is essential for patients to promptly report any signs of bleeding to their healthcare provider. 


Despite treatment, some patients may experience recurrent pulmonary embolism. This highlights the importance of long-term follow-up and adherence to prescribed medications. 

Chronic Thromboembolic Pulmonary Hypertension (CTEPH):

In some cases, clots may not completely dissolve and can lead to a condition called CTEPH, characterized by persistent high blood pressure in the pulmonary arteries. This condition may require specialized evaluation and treatment. 

Long-Term Management and Prognosis 

The prognosis for patients with a saddle pulmonary embolism can vary based on several factors, including the promptness of diagnosis, the effectiveness of treatment, and the presence of any underlying medical conditions. With timely and appropriate medical care, many patients can make a full recovery. 

Long-term management often involves: 

Continued Anticoagulation:

For many patients, long-term anticoagulant therapy is necessary to prevent recurrent clots. 

Regular Follow-Up:

Patients should maintain regular follow-up appointments with their healthcare providers to monitor their condition and adjust treatment as needed. 

Lifestyle Modifications:

Healthcare providers may recommend lifestyle changes, such as weight management, smoking cessation, and physical activity, to reduce the risk of future clots. 

Patient Education:

Educating patients about the importance of medication adherence and recognizing the signs of recurrent clots or bleeding is essential for their long-term well-being. 

Risk Factor Management:

Addressing and managing underlying risk factors for blood clots, such as genetic predispositions or certain medical conditions, can be crucial in preventing recurrence. 


Saddle pulmonary embolism is a severe medical condition that demands prompt diagnosis and treatment. Anticoagulant medications are a cornerstone of therapy, working to dissolve clots and prevent further complications.

The timeline for complete clot dissolution varies from patient to patient and depends on factors such as clot size, individual response to treatment, and overall health. 

Through careful monitoring, adherence to treatment plans, and lifestyle modifications, many patients can achieve a positive prognosis and minimize the risk of recurrent pulmonary embolism.

While saddle pulmonary embolism is a serious condition, advances in medical care and treatment options have significantly improved outcomes for those affected. 

If you or someone you know experiences symptoms suggestive of pulmonary embolism, such as sudden shortness of breath, chest pain, or coughing up blood, seek immediate medical attention.

Early intervention can be life-saving, and timely treatment from the best lung and sleep center plays a crucial role in ensuring a successful recovery. 

In summary, while the exact duration for a saddle pulmonary embolism to dissolve varies, the overarching message is clear: timely diagnosis, effective treatment, and ongoing management are paramount in the journey toward recovery and a healthy future. 

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