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

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.

scholarly journals Thrombolysis for massive pulmonary embolism in pregnancy: a case report

2011 ◽  
Vol 4 (1) ◽  
Author(s):  
Sergio Fasullo ◽  
Giorgio Maringhini ◽  
Gabriella Terrazzino ◽  
Filippo Ganci ◽  
Salvatore Paterna ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Case Report ◽  
Massive Pulmonary Embolism ◽  
In Pregnancy

scholarly journals Massive pulmonary embolism with cardiac arrest in pregnancy: A case report

2019 ◽  
Vol 19 (6) ◽  
pp. 186-189 ◽  
Author(s):  
Toru Miyoshi ◽  
Hideo Kawakami ◽  
Reiko Hori ◽  
Kazuo Nakanishi ◽  
Takehisa Kusumoto ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Case Report ◽  
Massive Pulmonary Embolism ◽  
In Pregnancy

Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature

Perfusion ◽  
2018 ◽  
Vol 34 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Rasha Al-Bawardy ◽  
Kenneth Rosenfield ◽  
Jorge Borges ◽  
Michael N. Young ◽  
Mazen Albaghdadi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Case Series ◽  
Massive Pulmonary Embolism ◽  
High Morbidity ◽  
Systemic Thrombolysis ◽  
Membrane Oxygenation ◽  
Intravenous Tissue Plasminogen Activator ◽  
Surgical Embolectomy

Background: Extracorporeal membrane oxygenation (ECMO) has been used to stabilize patients with massive pulmonary embolism though few reports describe this approach. We describe the presentation, management and outcomes of patients who received ECMO for massive pulmonary embolism (PE) in our pulmonary embolism response team (PERT) registry. Methods: We enrolled a consecutive cohort of patients with confirmed PE for whom PERT was activated and selected patients treated with ECMO. We prospectively captured clinical, therapeutic and outcome data at the time of PERT activation and during the follow-up period for up to 365 days. Results: Thirteen patients who had PERT activation with confirmed PE diagnosis have undergone ECMO since the initiation of our PERT program in 2012. The mean age was 49 ± 19 years. Six (46%) patients were female. All the patients had cardiac arrest, either as an initial presentation or in-hospital cardiac arrest after presentation. All the patients exhibited right ventricular (RV) dilation on echocardiogram with RV hypokinesis. Eight (62%) patients received systemic thrombolysis with intravenous tissue plasminogen activator (tPA) and three (23%) patients underwent catheter-directed thrombolysis therapy using the EKOS system (EKOS Corporation, Bothell, WA, USA). Four (31%) patients underwent surgical embolectomy. Mean ECMO duration was 5.5 days, ranging from 2-18 days. Thirty-day mortality was 31% and one-year mortality was 54%. Conclusions: Patients with massive pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. ECMO can be used in conjunction with systemic thrombolysis, catheter-directed therapy or as a bridge to surgical embolectomy.

Thrombolysis for massive pulmonary embolism in pregnancy: a case report

2011 ◽  
Vol 29 (6) ◽  
pp. 698.e1-698.e4 ◽  
Author(s):  
Sergio Fasullo ◽  
Sebastiano Scalzo ◽  
Giorgio Maringhini ◽  
Sergio Cannizzaro ◽  
Gabriella Terrazzino ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Case Report ◽  
Massive Pulmonary Embolism ◽  
In Pregnancy

scholarly journals Acute pulmonary embolism and systemic thrombolysis in the era of COVID-19 global pandemic 2020: a case series of seven patients admitted to a regional hospital in the French epidemic cluster

2021 ◽  
Author(s):  
John Philippe ◽  
Elena-Mihaela Cordeanu ◽  
Marie-Béatrice Leimbach ◽  
Stéphane Greciano ◽  
Wael Younes
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Case Series ◽  
Left Ventricular ◽  
Guideline Recommendation ◽  
Severity Scale ◽  
Systemic Thrombolysis ◽  
Increased Risk ◽  
Venous Thromboembolic Events

Abstract Background The novel Coronavirus [named severe acute respiratory syndrome-related coronavirus 2 (SARS CoV-2)] was associated with the development of acute respiratory distress syndrome (ARDS), which required mechanical ventilation in a high percentage of critically ill patients. Recent studies have highlighted a state of hypercoagulability in patients with SARS-CoV-2, leading to an increased risk of deep venous thrombosis (DVT) and pulmonary embolism (PE). The low proportion of PE-associated to DVT in COVID-19 patients may suggest that they have pulmonary thrombosis rather than embolism. There is no guideline recommendation on the treatment of massive PE in COVID-19 patients suffering from ARDS, without cardiogenic shock. Case summary We described a series of seven SARS-COV-2 patients diagnosed with PE, in our institution, who underwent the use of systemic thrombolysis (recombinant tissue plasminogen activator) according to the standard protocol of 10 mg over 15 min, then 90 mg over 120 min. Discussion According to the European Society of Cardiology (ESC) severity scale, three patients had high-risk PE and four had intermediate high-risk PE. Systemic thrombolysis was found to be associated with a reduction of the Brescia-COVID Respiratory Severity Scale in five patients, recording a reduction from 3 to 1 in 2/5 patients, and from 3 to 2 in 3/5 patients. Furthermore, 3/5 patients had an initial improvement of their alveolar partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio ranging from a 19% (Patient 3) to a 156% improvement (Patient 6). It was also associated with a decrease of the right ventricular (RV) dysfunction and the RV/left ventricular ratio 24 h later. No major bleeding events occurred after the thrombolysis, but the overall mortality after performing systemic thrombolysis was up to 3/7 patients. Conclusion Despite the low level of knowledge about the underlying pathophysiology of the COVID-19 ARDS, venous thromboembolic events, and the microvascular thrombosis, our findings suggest that in the treatment of PE with RV failure in patients with COVID-19 suffering from ARDS, without cardiogenic shock, systemic thrombolysis should be considered.

COVID-19 complicated by pulmonary embolism treated with catheter directed thrombectomy

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 333-337 ◽  
Author(s):  
Francisco Leonardo Galastri ◽  
Leonardo Guedes Moreira Valle ◽  
Breno Boueri Affonso ◽  
Marcela Juliano Silva ◽  
Rodrigo Gobbo Garcia ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Dynamic Process ◽  
Therapeutic Option ◽  
Massive Pulmonary Embolism ◽  
Percutaneous Intervention ◽  
Thromboembolic Events ◽  
Emergency Center ◽  
Catheter Directed Thrombolysis

Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.

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