Systemic Fibrinolytic Therapy in the Presence of Absolute Contraindication; a Case Series
Archives of Academic Emergency Medicine,
Vol. 6 No. 1 (2018),
1 January 2018
,
Page e25
https://doi.org/10.22037/aaem.v6i1.68
Abstract
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 complicationsfrom 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
How to Cite
References
Flinterman LE vHVA, Cannegieter SC, Rosendaal FR. Long-term survival in a large cohort of patients with venous thrombosis: incidence and predictors. PLoS Med 2012;9(1).
Goldhaber SZ VL, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;359:1386-9.
Fiumara K, Kucher N, Fanikos J, Goldhaber SZ. Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism. The American journal of cardiology. 2006;97(1):127-9.
Kanter DS, Mikkola KM, Patel SR, Parker JA, Goldhaber SZ. Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest. 1997;111(5):1241-5.
Meyer G, Gisselbrecht M, Diehl JL, Journois D, Sors H. Incidence and predictors of major hemorrhagic complications from thrombolytic therapy in patients with massive pulmonary embolism. The American journal of medicine. 1998;105(6):472-7.
Coon WW, Willis PW. Deep venous thrombosis and pulmonary
embolism: prediction, prevention and treatment. The American journal of cardiology. 1959;4:611-21.
Soloff LA, Rodman T. Acute pulmonary embolism. American Heart Journal.74(6):829-47.
Dalen JE, Alpert JS. Natural history of pulmonary embolism. Progress in cardiovascular diseases. 1975;17(4):259-70.
Miller GA, Sutton GC. Acute massive pulmonary embolism.
Clinical and haemodynamic findings in 23 patients studied by cardiac catheterization and pulmonary arteriography. British heart journal. 1970;32(4):518-23.
Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, et al. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. Jama. 2014;311(23):2414-21.
Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg
N, Goldhaber SZ, et al.Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123(16):1788-830.
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux
H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e419S-e96S.
Stein PD, Matta F, Steinberger DS, Keyes DC. Intracerebral hemorrhage with thrombolytic therapy for acute pulmonary embolism. The American journal of medicine. 2012;125(1):50-6.
Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. The American journal of medicine. 2012;125(5):465-70.
- Abstract Viewed: 255 times
- PDF Downloaded: 128 times
- HTML Downloaded: 75 times
