High-risk pulmonary embolism in the first trimester of pregnancy: Successful thrombolysis with tenecteplase

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: High-risk pulmonary embolism in pregnancy (n=1). Intervention: Tenecteplase. Primary outcome: Hemodynamic stabilization and maternal/fetal outcomes.

Q: What does this research mean for the field?

Thrombolytic therapy with tenecteplase can achieve favorable short-term outcomes in pregnant patients with high-risk pulmonary embolism in the first trimester. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ilyass Laaribi; Zakaria Bouayed; Iliass Benaini; Ikram Zaid; Houssam Bkiyar

doi:10.1016/j.radcr.2026.07.063

August 14, 2026Radiology Case ReportsOpen Access

High-risk pulmonary embolism in the first trimester of pregnancy: Successful thrombolysis with tenecteplase

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Key result

Tenecteplase successfully resolves high-risk PE in pregnancy with safe maternal and fetal outcomes.

n=1

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Why the study?

Pulmonary embolism is a life-threatening complication during pregnancy whose diagnosis is challenging due to nonspecific manifestations overlapping with pregnancy-related conditions.

Does tenecteplase improve outcomes in a pregnant woman with high-risk pulmonary embolism?

Key Points

To evaluate maternal and fetal outcomes following emergency thrombolysis with tenecteplase for hemodynamically unstable pulmonary embolism during the first trimester of pregnancy.
A 38-year-old woman (gravida 7, para 5) at 11 weeks of gestation presented with acute respiratory distress, hemodynamic instability, and acute right ventricular dysfunction.
Computed tomography pulmonary angiography confirmed bilateral pulmonary embolism after lower-limb compression ultrasonography showed negative results.
Systemic thrombolysis was administered via a single weight-adjusted bolus of tenecteplase (50 mg), followed by therapeutic anticoagulation with low-molecular-weight heparin.
Tenecteplase administration led to rapid hemodynamic stabilization and complete resolution of right ventricular dysfunction without maternal bleeding complications.
The intrauterine pregnancy remained viable and successfully continued to full term without adverse fetal outcomes.

Study Design

Type

Case Report (n=1)

Structured PICO

Does tenecteplase improve outcomes in a pregnant woman with high-risk pulmonary embolism?

P

Population

A 38-year-old pregnant woman in her first trimester presenting with high-risk bilateral pulmonary embolism and hemodynamic instability.

I

Intervention

Tenecteplase 50 mg intravenously over 5 minutes, followed by curative anticoagulation with low-molecular-weight heparin 6000 IU every 12 hours.

O

Outcome

Maternal and fetal survival, and resolution of hemodynamic instability and right ventricular dysfunction.hard clinical

Tenecteplase may be a viable and life-saving thrombolytic option for high-risk pulmonary embolism during the first trimester of pregnancy when alteplase is unavailable.

Limitations

Evidence for tenecteplase in pregnancy is limited to case reports and small case series.
Tenecteplase use in pregnancy remains off-label.
Fetal radiation exposure from diagnostic imaging.
Single case report
Off-label use of tenecteplase in pregnancy
Evidence limited to case reports and small case series

Implication

May support tenecteplase as alternative for high-risk PE in early pregnancy when alteplase unavailable; hypothesis-generating, needs prospective validation.

Abstract

Pulmonary embolism is a rare but potentially life-threatening complication during pregnancy, and its diagnosis remains challenging because of nonspecific clinical manifestations that may overlap with other pregnancy-related conditions. We report the case of a 38-year-old pregnant woman who presented with bilateral pulmonary embolism associated with hemodynamic and respiratory instability. Computed tomography pulmonary angiography was performed to confirm the diagnosis despite concerns regarding fetal radiation exposure, and the patient subsequently received thrombolytic therapy with a favorable short-term outcome. This case highlights the critical role of imaging in the diagnosis of high-risk pulmonary embolism during pregnancy and emphasizes the importance of timely multidisciplinary management. Early recognition and appropriate treatment are essential to improve maternal and fetal outcomes in this potentially fatal condition.

Discussion

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Cite This Study

Laaribi et al. (2026) conducted a case report in High-risk pulmonary embolism in pregnancy (n=1). Tenecteplase was evaluated on Hemodynamic stabilization and maternal/fetal outcomes. Tenecteplase successfully stabilized a 38-year-old pregnant woman with high-risk pulmonary embolism, leading to complete recovery and a healthy term delivery without maternal or fetal complications.

synapsesocial.com/papers/6a817a21f2fb91fc834adb8b https://doi.org/10.1016/j.radcr.2026.07.063

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High-risk pulmonary embolism in the first trimester of pregnancy: Successful thrombolysis with tenecteplase

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

High-risk pulmonary embolism in the first trimester of pregnancy: Successful thrombolysis with tenecteplase

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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