Two-edged Knife: Massive Pulmonary Embolism and Thrombolytic Contraindication

Öz

İntroduction: Pulmonary embolism is a common cause of death among emergency department admissions, and it has a high mortality and morbidity rate. Etiological reasons are generally associated with immobility. Radiological imaging methods are at the forefront in diagnosis. Anticoagulant and thrombolytic therapy may be preferred in treatment according to the hemodynamic condition of the patient. Case report: A 56-year-old female patient admitted to the emergency department with sudden onset of dyspnea and syncope with a condition of cardiogenic shock, and echocardiography revealed an enlargement of the right heart chambers and impaired functions, and a tomography was performed with the pre-diagnosis of pulmonary embolism. When systemic thrombolytic therapy was contraindicated in the patient who had embolism on tomography, catheter-based thrombectomy and selective low-dose thrombolytic therapy to the pulmonary artery were administered. The patient, who became hemodynamically stable and his shock condition improved, was discharged with anticoagulant therapy. Conclusion: When left untreated, pulmonary embolism is a disease with a high mortality rate. Although systemic thrombolytic treatments are contraindicated in some patients, successful results can be obtained with locally effective interventional treatments in these patient groups. Keywords: Pulmonary embolism, catheter-based thrombolysis, thrombolytic therapy

Anahtar Kelimeler

• Pulmonary embolism
• catheter-based thrombolysis
• thrombolytic therapy

Kaynakça

1. 1- Raskob GE, Angchaisuksiri P, Blanco AN. For the ISTH Steering Committee for World Thrombosis Day. Thrombosis: A major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34:2363-71.
2. 2- Virk H Ul H, Chatterjee S, Sardar P, Bavishi C, Giri J, Chatterjee S. Systemic thrombolysis for pulmonary embolism: Evidence, patient selection, and protocols for management. Intervent Cardiol Clin. 2018;7(1):71-80.
3. 3- Crous-Bou M, Harrington LB, Kabrhel C. Environmental and genetic risk factors associated with venous thromboembolism. Semin Thromb Hemost 2016;42(8):808–820.
4. 4- Wendelboe AM, Raskob GE. Global burden of thrombosis: Epidemiologic aspects. Circ Res 2016;118:1340-7.
5. 5- Arseven O, Sevinç C, Ekim N. Pulmoner tromboembolism tanı ve tedavi uzlaşı raporu. Türk Toraks Derneği. 2015.
6. 6- Pollack CV, Schreiber D, Goldhaber SZ. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: İnitial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol. 2011;57: 700-6.
7. 7- Stein PD, Terrin ML, Hales CA. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100:598.
8. 8- Marti C, John G, Konstantinides S, Combescure C, Sanchez O, Lankeit M, et al. Systemic thrombolytic therapy for acute pulmonary embolism: A systematic review and meta-analysis. Eur Heart J. 2015;36: 605-14.

9. 9- Konstantinides SV, Torbicki A, Agnelli G. ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2019;35(43):3033-80.
10. 10- Kucher N, Boekstegers P, Müuller OJ. Randomized, controlled trial of ultrasound- assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation. 2014;129:479-86.