Use of Catheter-Directed Thrombolytic Therapy for Ongoing Shock After Systemic Thrombolysis for Massive Pulmonary Embolism

We present a clinical case of successful systemic thrombolysis in a pregnant patient with massive pulmonary embolism. A 29-year old patient at 28 weeks of pregnancy was hospitalized 2 hours after sudden suffocation in a presyncopal state and hypotension of 90/50 mm Hg. ECG showed the signs of overload of right heart chambers in the form of a typical S1-Q3-T3 (McGinn–White) syndrome, as well as the Kosuge sign. Echocardiography verified pulmonary 3 Grade hypertension (81 mm Hg), enlargement of the right atrium and ventricle, 3 Grade tricuspid regurgitation and paradoxical movement of the interventricular septum. Multislice computed tomography of the chest with contrast of the pulmonary artery revealed a defect of contrast in the right main pulmonary artery, occlusive clearance, and thrombotic mass, extending to the bifurcation of the left main pulmonary artery ("clot - rider"). Thrombolytic therapy was started with recombinant tissue plasminogen activator (alteplase 10 mg bolus, then 90 mg for 2 hours). The patient was daily examined by a gynecologist. The viability of the fetus, monitoring of possible hemorrhagic complications of the placenta were evaluated. After thrombolysis, the patient began to note clinical improvement in the form of a regression of dyspnea. According to echocardioscopy control, the signs of overload of right heart chambers completely regressed. There were no complications both in the mother and in the fetus during the subsequent days until discharge. On 25.05.16 there was uncomplicated delivery vaginally of live full-term girl. Thus, when there is life-threatening massive pulmonary embolism, the application of General principles of diagnosis and treatment of this disease in patients with pregnancy is warranted. The carrying out of thrombolytic therapy in massive pulmonary embolism enables to reduce the manifestations of pulmonary hypertension, right ventricular failure, and to conduct births on time. Used intravenous thrombolytics have no teratogenic effect in the later stages of pregnancy.Received 18 April 2017. Accepted 5 June 2017.Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest.

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

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2008.11.010 ◽

2009 ◽

Vol 5 (2) ◽

pp. 271-274 ◽

Cited By ~ 4

Author(s):

Rudolf A. Weiner ◽

Markos Daskalakis ◽

Sophia Theodoridou ◽

Sven Fassbender ◽

Karin Parutsch

Keyword(s):

Bariatric Surgery ◽

Pulmonary Embolism ◽

Postoperative Period ◽

Massive Pulmonary Embolism ◽

Systemic Thrombolysis

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Case Report Acute Cor Pulmonale Due to Massive Pulmonary Embolism and Successful Response to Thrombolytic Therapy

The American Journal of the Medical Sciences ◽

10.1097/00000441-198203000-00009 ◽

1982 ◽

Vol 283 (2) ◽

pp. 99-105

Author(s):

Suman Vardan ◽

Harold Smulyan

Keyword(s):

Pulmonary Embolism ◽

Case Report ◽

Thrombolytic Therapy ◽

Massive Pulmonary Embolism ◽

Cor Pulmonale ◽

Acute Cor Pulmonale

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Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis

European Journal of Case Reports in Internal Medicine ◽

10.12890/2019_001150 ◽

2019 ◽

Author(s):

Ricardo Cleto Marinho ◽

José Luis Martins ◽

Susana Costa ◽

Rui Baptista ◽

Lino Gonçalves ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Pericardial Effusion ◽

Thrombolytic Therapy ◽

Cardiac Tamponade ◽

Massive Pulmonary Embolism ◽

Extensive Study ◽

Life Saving ◽

Obstructive Shock

Background: The occurrence of a high-risk pulmonary embolism (PE) within 48 hours of a complicated pericardiocentesis to remove a haemorrhagic pericardial effusion, is an uncommon clinical challenge. Case summary: The authors report the case of a 75-year-old woman who presented with signs of imminent cardiac tamponade due to recurring idiopathic pericardial effusion. The patient underwent pericardiocentesis that was complicated by the loss of 1.5 litres of blood. Within 48 hours, the patient had collapsed with clear signs of obstructive shock. This was a life-threating situation so alteplase was administered after cardiac tamponade and hypertensive pneumothorax had been excluded. CT chest angiography later confirmed bilateral PE. The patient achieved haemodynamic stability less than an hour after receiving the alteplase. However, due to the high risk of bleeding, the medical team suspended the thrombolysis protocol and switched to unfractionated heparin within the hour. The cause of the PE was not identified despite extensive study, but after 1 year of follow-up the patient remained asymptomatic. Discussion: Despite the presence of a contraindication, the use of thrombolytic therapy in obstructive shock after exclusion of hypertensive pneumothorax can be life-saving, and low-dose thrombolytic therapy may be a valid option in such cases.

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Systemic thrombolysis in a patient with massive pulmonary embolism and recent glioblastoma multiforme resection

BMJ Case Reports ◽

10.1136/bcr-2017-221578 ◽

2017 ◽

pp. bcr-2017-221578 ◽

Cited By ~ 1

Author(s):

Joshua Lampert ◽

Behnood Bikdeli ◽

Philip Green ◽

Matthew R Baldwin

Keyword(s):

Pulmonary Embolism ◽

Glioblastoma Multiforme ◽

Massive Pulmonary Embolism ◽

Systemic Thrombolysis

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Forearm Compartment Syndrome following Thrombolytic Therapy for Massive Pulmonary Embolism: A Case Report and Review of Literature

Case Reports in Orthopedics ◽

10.1155/2011/678525 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Ravi Badge ◽

Mukesh Hemmady

Keyword(s):

Pulmonary Embolism ◽

Thrombolytic Therapy ◽

Compartment Syndrome ◽

Signs And Symptoms ◽

Massive Pulmonary Embolism ◽

Heparin Therapy ◽

Arterial Line ◽

The Right ◽

High Index Of Suspicion ◽

Passive Stretch

Use of thrombolytic therapy in pulmonary embolism is restricted in cases of massive embolism. It achieves faster lysis of the thrombus than the conventional heparin therapy thus reducing the morbidity and mortality associated with PE. The compartment syndrome is a well-documented, potentially lethal complication of thrombolytic therapy and known to occur in the limbs involved for vascular lines or venepunctures. The compartment syndrome in a conscious and well-oriented patient is mainly diagnosed on clinical ground with its classical signs and symptoms like disproportionate pain, tense swollen limb and pain on passive stretch. However these findings may not be appropriately assessed in an unconscious patient and therefore the clinicians should have high index of suspicion in a patient with an acutely swollen tense limb. In such scenarios a prompt orthopaedic opinion should be considered. In this report, we present a case of acute compartment syndrome of the right forearm in a 78 years old male patient following repeated attempts to secure an arterial line for initiating the thrombolytic therapy for the management of massive pulmonary embolism. The patient underwent urgent surgical decompression of the forearm compartments and thus managed to save his limb.

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