Systemic thrombolysis for acute massive pulmonary embolism in the immediate postoperative period after bariatric surgery

Acute myocardial infarction, stroke and pulmonary embolism required a prompt revascularization to restore the normal blood flow as soon as possible. Fibrinolytic treatment has gradually become both dated and underused in the treatment of acute myocardial infarction, after the wide diffusion of cathlab and percutaneous transluminal coronary angioplasty. Conversely, the use of systemic thrombolysis remained a benchmark in the treatment of both ischemic stroke and massive pulmonary embolism. In daily clinical practice, the use of thrombolytic agents is often limited by absolute and/or relative contraindications and possible adverse events after the drug administration, as intracranial and/or extracranial bleeding events. To minimize these problems, during the last years, the introduction of nanotechnology in the field of cardiovascular revascularization medicine has created several fascinating results. In the present article, we describe these recent findings and their possible implications in future clinical practice.

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A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism

Vascular Medicine ◽

10.1177/1358863x17730430 ◽

2017 ◽

Vol 23 (1) ◽

pp. 65-71 ◽

Cited By ~ 16

Author(s):

Akhilesh K Sista ◽

Oren A Friedman ◽

Eda Dou ◽

Brendan Denvir ◽

Gulce Askin ◽

...

Keyword(s):

Pulmonary Embolism ◽

Brain Cancer ◽

Massive Pulmonary Embolism ◽

Bleeding Rate ◽

Systemic Thrombolysis ◽

Multidisciplinary Assessment ◽

Catheter Directed Thrombolysis ◽

Assessment And Treatment ◽

Institutional Experience ◽

Hospital Deaths

Pulmonary Embolism Response Teams (PERTs) have emerged to provide rapid multidisciplinary assessment and treatment of PE patients. However, descriptive institutional experience and preliminary outcomes data from such teams are sparse. PERT activations were identified through a retrospective review. Only confirmed submassive or massive PEs were included in the data analysis. In addition to baseline variables, the therapeutic intervention, length of stay (LOS), in-hospital mortality, and bleeding rate/severity were recorded. A total of 124 PERT activations occurred over 20 months: 43 in the first 10 months and 81 in the next 10. A total of 87 submassive (90.8%) and massive (9.2%) PE patients were included. The median age was 65 (51–75 IQR) years. Catheter-directed thrombolysis (CDT) was administered to 25 patients, systemic thrombolysis (ST) to six, and anticoagulation alone (AC) to 54. The median ICU stay and overall LOS were 6 (3–10 IQR) and 7 (4–14 IQR) days, respectively, with no association with any variables except a brain natriuretic peptide (BNP) >100 pg/mL ( p=0.008 ICU LOS; p=0.047 overall LOS). Twelve patients (13.7%) died in the hospital, nine of whom had metastatic or brain cancer, with a median overall LOS of 13 (11–17 IQR) days. There were five major bleeds: one in the CDT group, one in the ST group, and three in the AC group. Overall, (1) PERT activations increased after the first 10 months; (2) BNP >100 pg/mL was associated with a longer LOS; (3) rates of mortality and bleeding did not correlate with treatment; and (4) the majority of in-hospital deaths occurred in patients with advanced cancer.

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Systemic Thrombolysis for Treatment of Postpartum Saddle Embolism Complicated by Postpartum Hemorrhage: A Case Report and Brief Literature Review

Case Reports in Obstetrics and Gynecology ◽

10.1155/2021/5553296 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Kathy Mostajeran ◽

Hillary Boswell ◽

Ziad Haidar

Keyword(s):

Pulmonary Embolism ◽

Case Report ◽

Postpartum Hemorrhage ◽

Postpartum Period ◽

Case Series ◽

Massive Pulmonary Embolism ◽

Thromboembolic Events ◽

Systemic Thrombolysis ◽

Venous Thromboembolic Events ◽

In Pregnancy

Venous thromboembolic events (VTE), specifically pulmonary embolisms, account for a significant portion of maternal morbidity and mortality. Due to the procoagulant physiological changes that occur, pregnancy and the postpartum period are known risk factors for thromboembolic events. The risk is greatest during the first-week postpartum and remains elevated for up to six weeks as compared to the general population. Treatment guidelines regarding the use of thrombolytics for massive pulmonary embolism occurring in pregnancy and the postpartum are not well established. In nonpregnant populations, thrombolytic agents are well known to decrease the mortality in the setting of a massive pulmonary embolism. However, in the absence of management guidelines, thrombolysis in pregnancy remains guided by case reports and case series. We present a case of a massive pulmonary embolism (PE) causing hemodynamic instability during the postpartum period treated with tissue plasminogen activator (tPA). The case was complicated by delayed postpartum hemorrhage successfully managed with the uterotonic methylergometrine. The patient was started on oral anticoagulation and continued for six months without recurrent VTE. Our case demonstrates a rare occurrence of a saddle embolism after a vaginal delivery within the first postpartum week which was successfully managed with the use of systemic thrombolysis and minimal intervention to manage the iatrogenic delayed postpartum hemorrhage. To the authors’ knowledge, no other similar case report exists. This case highlights the need to develop guidelines for the use of thrombolysis in mothers who present with massive pulmonary embolus and a noninvasive means to manage adverse bleeding events in the puerperium.

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Time to Systemic Thrombolysis in Confirmed Massive Pulmonary Embolism in a Single Center

10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3728 ◽

2021 ◽

Author(s):

B. Kwok ◽

A. Katz ◽

F. Dikengil ◽

S. Gayen ◽

M. Zheng ◽

...

Keyword(s):

Pulmonary Embolism ◽

Massive Pulmonary Embolism ◽

Single Center ◽

Systemic Thrombolysis

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Successful treatment of massive pulmonary embolism using a pulmonary artery catheter during prolonged normothermic cardiopulmonary resuscitation

Acute Medicine Journal ◽

10.52964/amja.0359 ◽

2014 ◽

Vol 13 (3) ◽

pp. 118-120

Author(s):

Elisabeth Dovern ◽

◽

Marlene R. Mende ◽

Niels J Elderson ◽

Eelko Ronner ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cardiopulmonary Resuscitation ◽

Pulmonary Artery ◽

Pulmonary Artery Catheter ◽

Treatment Options ◽

Tertiary Care ◽

Massive Pulmonary Embolism ◽

Neurological Recovery ◽

Successful Outcome ◽

Systemic Thrombolysis

Massive pulmonary embolism has a high mortality rate. Standard treatment includes systemic thrombolysis. If this fails, surgical embolectomy or a percutaneous catheter-guided approach is advised in current guidelines. However, these treatment options might not be available in many non-tertiary care hospitals. We describe a case of a 25-year old woman with cardiac arrest from massive pulmonary embolism. She was treated with thrombus fragmentation using a pulmonary artery catheter and intra-pulmonary thrombolysis after failure of systemic thrombolysis along with 90 minutes of cardiopulmonary resuscitation (CPR). Neurological recovery was excellent and pulmonary pressure was normalized after one month. Besides catheter guided thrombus fragmentation and thrombolysis, we contribute the successful outcome to a combination of ultrasound-guided therapy, capnography-guided CPR, and “crew resource management” principles. Our case illustrates that a pulmonary artery catheter can be used successfully in a non-tertiary setting, to perform a percutaneous procedure during CPR and that full neurological recovery is possible after 90 minutes of CPR.

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Massive pulmonary embolism presenting initially as acute psychosis

BMJ Case Reports ◽

10.1136/bcr-2017-222018 ◽

2019 ◽

Vol 12 (4) ◽

pp. e222018

Author(s):

Michael Lawrenz Ferreras Co ◽

Arianne Clare Agdamag ◽

Marcus Juan Esteban ◽

Roselyn Mateo

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Embolism ◽

Life Support ◽

Massive Pulmonary Embolism ◽

Psychotic Symptoms ◽

Acute Psychosis ◽

Systemic Thrombolysis ◽

The Third ◽

Ventricular Response ◽

New Onset

This is a case of a 68-year-old man with Parkinson’s disease who was admitted in the psychiatry floor for new-onset aggressive behaviour and hallucinations. On the third day of hospitalisation, he suddenly developed dyspnoea followed by an ECG showing atrial fibrillation with rapid ventricular response. A few seconds later, he went into cardiac arrest; he was resuscitated after multiple rounds of Advanced Cardiovascular Life Support. A transthoracic echo showed hypokinetic and enlarged right ventricle. A CT Chest showed a saddle embolus. Patient was provided with systemic thrombolysis, which led to an improvement in his haemodynamic status. Interestingly, his psychotic symptoms also improved. In this paper, we present and review how pulmonary embolism can be associated with acute psychosis.

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