This case demonstrates the successful sequential use of PCI and thrombolysis, along with tailored antithrombotic therapy, for the rare and life-threatening combination of paradoxical embolic MI and massive PE in a patient with severe anemia.
Highlights need to consider paradoxical embolism in concurrent PE and MI; leaves open optimal management in anemic patients.
The article describes a clinical case of a 44-year-old woman with almost simultaneous onset of massive pulmonary embolism (bilateral involvement) secondary to posterior tibial vein thrombosis with a floating thrombus, and embolic myocardial infarction caused by paradoxical embolism through an atrial septal defect. These events occurred against a background of severe anemia of unknown etiology. The management strategy initial primary percutaneous coronary intervention for type 2 myocardial infarction and thrombotic occlusion of the posterior interventricular artery with stent implantation, and subsequent thrombolytic therapy for pulmonary embolism. The article further discusses the complex issues of prescribing and adjusting antithrombotic therapy based on decisions by medical council, which led to significant clinical improvement by the time of the patient’s discharge.
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Lyakhovich et al. (2025) studied this question.
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