Introduction: Systemic thrombolysis is the treatment of choice for hemodynamically unstable patients with acute pulmonary embolism (PE) while for the intermediate-high risk ones the possibility of severe bleeding seems to outweigh the benefits. Surgical or percutaneous therapy is an option in case of contraindication/failure of fibrinolysis but they are not available in every hospital. Case Report: An 85-year-old woman arrived at the Emergency Department for rapid onset dyspnea, thoracic pain with hypotension, tachycardia, and hypoxia. A computed tomography pulmonary angiography revealed acute PE of the main branches of the pulmonary right and left arteries. Due to hemodynamic instability and a history of recent intestinal resection surgery (25 days before), a continuous infusion of low-dose thrombolysis regimen with 50 mg rt-PA in 2 hours was started. After 30 minutes of rt-PA infusion, all vital signs were improved and at the end of rt-PA infusion. Point of care ultrasound (POCUS) revealed a reduced size of right ventricle with a decrease in right/left ventricle ratio. Hospital stay and a follow-up at two weeks revealed no complication due to the fibrinolytic administration or anticoagulant therapy. Conclusion: Anticoagulation is still the cornerstone therapy for patients with PE, but there’s a lack of trials on reperfusion strategy. Moreover, different guidelines give different short-term risk classifications, indication, and dosage of thrombolytic drugs and absolute and relative contraindications to systemic thrombolysis. This case report shows the potential benefit of low-dose rt-PA in patients with relative contraindications to thrombolysis and presenting with vital signs compatible with hemodynamic instability.
Low-dose systemic thrombolysis in patient with recent major abdominal surgery and high-risk pulmonary embolism: Case report and narrative review
Domenico Spampinato, Michele
Ultimo
2021
Abstract
Introduction: Systemic thrombolysis is the treatment of choice for hemodynamically unstable patients with acute pulmonary embolism (PE) while for the intermediate-high risk ones the possibility of severe bleeding seems to outweigh the benefits. Surgical or percutaneous therapy is an option in case of contraindication/failure of fibrinolysis but they are not available in every hospital. Case Report: An 85-year-old woman arrived at the Emergency Department for rapid onset dyspnea, thoracic pain with hypotension, tachycardia, and hypoxia. A computed tomography pulmonary angiography revealed acute PE of the main branches of the pulmonary right and left arteries. Due to hemodynamic instability and a history of recent intestinal resection surgery (25 days before), a continuous infusion of low-dose thrombolysis regimen with 50 mg rt-PA in 2 hours was started. After 30 minutes of rt-PA infusion, all vital signs were improved and at the end of rt-PA infusion. Point of care ultrasound (POCUS) revealed a reduced size of right ventricle with a decrease in right/left ventricle ratio. Hospital stay and a follow-up at two weeks revealed no complication due to the fibrinolytic administration or anticoagulant therapy. Conclusion: Anticoagulation is still the cornerstone therapy for patients with PE, but there’s a lack of trials on reperfusion strategy. Moreover, different guidelines give different short-term risk classifications, indication, and dosage of thrombolytic drugs and absolute and relative contraindications to systemic thrombolysis. This case report shows the potential benefit of low-dose rt-PA in patients with relative contraindications to thrombolysis and presenting with vital signs compatible with hemodynamic instability.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
