Key result
Unfractionated heparin and supportive care successfully manage massive PE and LV thrombus when thrombolysis is contraindicated.
Why the study?
Massive PE typically requires systemic thrombolysis, but concurrent left ventricular thrombus creates a relative contraindication due to high risk of systemic embolization, necessitating individualized management.
Case Report (n=1)
Individualized management with unfractionated heparin and supportive care can be successful in high-risk massive PE patients with contraindications to thrombolysis such as LV thrombus.
May support individualized therapy for massive PE with LV thrombus; leaves open optimal strategies pending prospective data.
Massive pulmonary embolism (PE) is a life-threatening condition typically requiring systemic thrombolysis. The presence of a left ventricular (LV) thrombus represents a relative contraindication due to the high risk of systemic embolization, requiring individualized management. We present a 73-year-old woman with a history of non-Hodgkin lymphoma in remission, severe LV dysfunction from chemotherapy and radiotherapy, permanent atrial fibrillation under apixaban, and stage 3 chronic kidney disease. She presented with progressive dyspnea, edema, and syncope. On admission, she presented with cardiogenic shock. Imaging confirmed massive bilateral PE and an LV intracavitary thrombus. Thrombolysis was contraindicated due to multiple high-risk factors: LV thrombus, ongoing anticoagulation, advanced age, and renal dysfunction. Management consisted of therapeutic anticoagulation with unfractionated heparin, vasopressor and inotropic support, and close monitoring, showing progressive clinical improvement. This case highlights the complexity of managing massive PE in cardio-oncology patients and underscores the need for individualized strategies when thrombolysis poses unacceptable risks.
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Solórzano et al. (2026) conducted a case report in Massive pulmonary embolism and left ventricular intracavitary thrombus (n=1). Therapeutic anticoagulation with unfractionated heparin and supportive care was evaluated on Clinical improvement. Therapeutic anticoagulation with unfractionated heparin and supportive care led to progressive clinical improvement in a patient with massive PE and LV thrombus where thrombolysis was contraindicated.
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