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Systemic Fibrinolytic Therapy in the Presence of Absolute Contraindication; a Case Series

Mahdi Pishgahi, Toktam Alirezaei, Behzad Hajimoradi, S.Mojtaba Nekooghadam, Shima Shahi




In massive pulmonary embolism (PE), fibrinolytic therapy is a potential lifesaving treatment; therefore, if other treatments are not available, the physicians encounter this question: can we accept the risk of complications
from fibrinolytic therapy, especially intracranial hemorrhage, in the presence of absolute contraindication, in order to save the patient’s life? Here, we describe three cases of massive PE with absolute contraindication for
fibrinolytic therapy who presented to emergency department following dyspnea. Since, surgical or catheter embolectomy were not available and patients were very high risk for transferring to another hospital, systemic
fibrinolytic was administered. The patients improved clinically and were discharged from hospital. It seems that, if no other acceptable treatments are available, physicians could consider fibrinolytic therapy, even at the
presence of contraindication, to save the patient’s life.


Massive Pulmonary embolism; fibrinolytic therapy; anticoagulant; absolute contraindication


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DOI: https://doi.org/10.22037/emergency.v6i1.21162


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