Interv Akut Kardiol 2011; 10(Suppl. A): 20-22

Aggressive approach in thrombolytic therapy of massive pulmonary embolism

Viktor Talafa¹, Dalibor Pastucha²

¹ Jednotka intenzivní péče Interního oddělení Nemocnice ve Frýdku-Místku

² Klinika rehabilitačního a tělovýchovného lékařství FN Olomouc

Pulmonary embolism (PE) is a relatively frequent condition, particularly in elderly and at-risk patients. The incidence ranges from 0.8 to

2 cases per 1,000 population and year. Most commonly, it results from a sudden obstruction of part of pulmonary vascular bed by

a thromboembolus originating in the deep venous system of the lower extremities. The treatment of patients with acute PE depends on

several factors with the patient’s haemodynamic condition being the most important. In the presence of circulatory instability, alteplase,

a thrombolytic agent, is the first-choice drug but it is necessary to take into account absolute contraindications. In a patient with a stable

circulation, conventional anticoagulation therapy with heparin or low-molecular-weight heparin is administered. The administration

of thrombolytic therapy in haemodynamically stable patients with pronounced right ventricular dysfunction is debatable. The present

case report describes a case of repeated administration of thrombolytic therapy in a female patient with two episodes of cardiogenic

shock secondary to recurrent massive pulmonary embolism within a short time interval. Surgical embolectomy is the second therapeutic

option for recurrent massive PE. The case report suggests rescue thrombolysis as the only treatment option in the setting of an intensive

care unit of a district hospital.

Keywords: massive pulmonary embolism, thrombolytic therapy, Actilyse

Published: June 1, 2011  Show citation