Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis
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 immin...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SMC MEDIA SRL
2019-07-01
|
| Series: | European Journal of Case Reports in Internal Medicine |
| Subjects: | |
| Online Access: | https://www.ejcrim.com/index.php/EJCRIM/article/view/1150 |
| _version_ | 1811198115987849216 |
|---|---|
| author | Ricardo Cleto Marinho José Luis Martins Susana Costa Rui Baptista Lino Gonçalves Fátima Franco |
| author_facet | Ricardo Cleto Marinho José Luis Martins Susana Costa Rui Baptista Lino Gonçalves Fátima Franco |
| author_sort | Ricardo Cleto Marinho |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T01:26:24Z |
| format | Article |
| id | doaj.art-7796f206c6a74c7196ff1dedf33f3a5f |
| institution | Directory Open Access Journal |
| issn | 2284-2594 |
| language | English |
| last_indexed | 2024-04-12T01:26:24Z |
| publishDate | 2019-07-01 |
| publisher | SMC MEDIA SRL |
| record_format | Article |
| series | European Journal of Case Reports in Internal Medicine |
| spelling | doaj.art-7796f206c6a74c7196ff1dedf33f3a5f2022-12-22T03:53:39ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942019-07-0110.12890/2019_0011501150Alteplase for Massive Pulmonary Embolism after Complicated PericardiocentesisRicardo Cleto Marinho0José Luis Martins1Susana Costa2Rui Baptista3Lino Gonçalves4Fátima Franco5Internal Medicine Department, Oporto University Hospital Center, Oporto, PortugalCardiology Department, Baixo Vouga Hospital Center, Aveiro, PortugalCardiology Department, Coimbra University Hospital Center, Coimbra, PortugalCardiology Department, Coimbra University Hospital Center, Coimbra, PortugalCardiology Department, Coimbra University Hospital Center, Coimbra, PortugalCardiology Department, Coimbra University Hospital Center, Coimbra, PortugalBackground: 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.https://www.ejcrim.com/index.php/EJCRIM/article/view/1150Pulmonary embolismalteplasepericardiocentesispericardial effusionthrombolytic therapy |
| spellingShingle | Ricardo Cleto Marinho José Luis Martins Susana Costa Rui Baptista Lino Gonçalves Fátima Franco Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis European Journal of Case Reports in Internal Medicine Pulmonary embolism alteplase pericardiocentesis pericardial effusion thrombolytic therapy |
| title | Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis |
| title_full | Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis |
| title_fullStr | Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis |
| title_full_unstemmed | Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis |
| title_short | Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis |
| title_sort | alteplase for massive pulmonary embolism after complicated pericardiocentesis |
| topic | Pulmonary embolism alteplase pericardiocentesis pericardial effusion thrombolytic therapy |
| url | https://www.ejcrim.com/index.php/EJCRIM/article/view/1150 |
| work_keys_str_mv | AT ricardocletomarinho alteplaseformassivepulmonaryembolismaftercomplicatedpericardiocentesis AT joseluismartins alteplaseformassivepulmonaryembolismaftercomplicatedpericardiocentesis AT susanacosta alteplaseformassivepulmonaryembolismaftercomplicatedpericardiocentesis AT ruibaptista alteplaseformassivepulmonaryembolismaftercomplicatedpericardiocentesis AT linogoncalves alteplaseformassivepulmonaryembolismaftercomplicatedpericardiocentesis AT fatimafranco alteplaseformassivepulmonaryembolismaftercomplicatedpericardiocentesis |