Successful Low-Dose Thrombolysis of Submassive Pulmonary Embolus in a Pregnant Patient: A Case Report

Abstract

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(Pulmonary embolus is an important cause of morbidity and mortality during pregnancy with a high case fatality rate. Due to presumed risk of maternal bleeding and fetal complications, thrombolytic therapy is relatively contraindicated during pregnancy. Thrombolysis for pulmonary embolus in pregnancy has only been used in haemodynamic compromise with shock. A 37-year-old patient presented at 34 weeks gestation with progressive breathlessness, with symptoms at rest. She had clinical signs of deep vein thrombosis and was tachycardic, tachypnoeic but had a normal systemic arterial blood pressure. Pulmonary embolus was confirmed and transthoracic echocardiography demonstrated right ventricular dysfunction and right ventricular pressure overload. Despite optimal anticoagulation therapy, the patient deteriorated clinically but remained normotensive. We administered thrombolytic therapy with 50% of the conventional dose of recombinant tissue-type plasminogen activator (Alteplase). The clinical and haemodynamic response to treatment was excellent, with no maternal or fetal complications at the time or in subsequent days to discharge.)




doi: http://dx.doi.org/10.4021/cr284w