B64-52 Iatrogenic Acute Blood Loss Anemia Following Mechanical Thrombectomy

Abstract Introduction Thrombectomy is indicated for intermediate to high-risk pulmonary embolism. There continues to be debate on the indication for thrombolytics vs. thrombectomy. In some trials, including the FLAME trial, there was significant reduction in all-cause mortality with thrombectomy vs. thrombolytics or anticoagulation alone. Previous trials indicate there is risk of anemia post operatively (15% in trial, 4% with flow saver). Prior literature looking at thrombectomy and associated outcomes with anemia were completed with acute ischemic stroke. Literature has shown worsened mortality and reduced functional outcomes in patients with preoperative anemia. Case Presentation 62-year-old male with a history of JAK2 negative essential thrombocythemia presented with chest tightness radiating to his axilla and hands bilaterally that started two weeks prior to presentation with mild dyspnea on exertion and resolved with rest. Acute worsening of his chest tightness caused presentation to ED.On presentation, patient was not hypoxic, and hemodynamically stable. CBC significant for pancytopenia with Hgb 9.6, WBCs 2.98, platelets 116. BNP and HST were unremarkable. CTA PE was significant for large saddle pulmonary embolism in the main left and right pulmonary arteries with additional filling defects in right middle lobe, right lower lobe and left lower lobe. There was no radiographic or ECG evidence of right heart strain. TTE showing EF 60-65%, normal RV size and function. RVSP was unable to be determined. PESI Score of 102/Class III, indicating intermediate risk. Heparin infusion was initiated, and interventional radiology was consulted for thrombectomy. Thrombectomy was completed without reported complication; patient underwent 5 passes with flow saver device usage. Anemia worsened overnight; hemoglobin decreased to 6.0 from 9.6, additionally, patient developed chest pain and was transferred to MICU. Repeat CTA PE completed with no evidence of retroperitoneal bleed, and peripheralization of previous clot. Heparin infusion was resumed after patient was transfused with two units of blood. Discussion Mechanical thrombectomy has been guideline directed for patients with high-risk pulmonary embolisms and high risk for bleed. Recent data indicates that these procedures have low all-cause mortality and low bleeding risk. This is a rare case of mechanical thrombectomy associated acute blood loss anemia, even with usage of flow saver device, complicated by JAK2 negative essential thrombocythemia. Previous studies evaluated outcomes of thrombectomy of acute ischemic stroke, which showed worsened outcomes. This case demonstrates the further need to evaluate outcomes of PE thrombectomy with preoperative anemia and patients with large intermediate risk PE. This abstract is funded by: None