Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida: A case report

• Published in: Medicine (Baltimore) Vol. 97; no. 43; p. e12985
• Main Authors: Liao, Jiyang, Lai, Fang, Xie, Dongping, Han, Yun, Mai, Shutao, Weng, Yanna, Zhang, Yan, Du, Jiongdong, Zhou, Gengbiao
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.10.2018
• Subjects: Abortion, Induced; Adult; Clinical Case Report; Female; Fibrinolytic Agents - administration & dosage; Humans; Pregnancy; Pregnancy Complications - drug therapy; Pulmonary Embolism - complications; Pulmonary Embolism - drug therapy; Thrombolytic Therapy; Tissue Plasminogen Activator - administration & dosage
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000012985

Thrombolysis in primigravida with hemodynamic instability is controversial, especially treatment with low-dosage recombinant tissue plasminogen activator (rtPA), and related studies are extremely rare. Here, we report the case of a 26-year-old primigravida diagnosed with an acute massive pulmonary embolism (PE) that prompted initiation of thrombolysis with low-dose alteplase. The patient was admitted to the Emergency Department with chief complaints of a sudden onset of extremely dyspnea, chest tightness, and confusion over a 6-hour period. She was found to have significant dilation of her right ventricle, moderate pulmonary arterial hypotension, as shown by transthoracic echocardiography, and a typical S1-Q3-T3 pattern, as shown by electrocardiogram (ECG). Acute massive PE in primigravida. The patient underwent intravenous thrombolysis with a half dose of alteplase. The fetus lived through this severe event during the mother's stay in the Intensive Care Unit; however, surgical abortion was unexpectedly proposed due to long-term hypoxia and high-risk of relapse and exacerbation and was performed successfully after the agreement of her kin. The patient recovered gradually, and results of her laboratory tests and postsurgical, repeated contrast-enhanced computed tomography had normalized by her 3-month follow-up. Administration of low-dosage alteplase in primigravida with hemodynamic instability is extremely rare and controversial; however, our case suggests that this treatment strategy is relatively safe and feasible. In addition, nonradiometric examination played a major role in the diagnosis of PE in this patient. Because radiation use is contraindicated during pregnancy, these examinations could be the first choice for pregnant patients with suspected PE.