Why the study?
Acute massive pulmonary thromboembolism requires urgent management, and half-dose alteplase may successfully lyse clots, especially when bleeding is a concern.
Low-dose thrombolysis may be a successful and safer alternative for managing acute massive pulmonary embolism, particularly when bleeding risk is a concern.
May support low-dose thrombolysis in high-bleeding-risk massive PE; hypothesis-generating case report requiring prospective trials before practice change.
Introduction: and importance: Acute massive pulmonary thromboembolism is a potentially life-threatening condition requiring urgent management to decrease mortality. Although the standard dose of systemic thrombolysis with alteplase is 100 mg, half the dose of alteplase can be used to break up clots successfully, especially if bleeding is a concern. Case presentation: We report a case of massive pulmonary thromboembolism presenting with cardiopulmonary arrest, successfully managed with advanced cardiac life support, anticoagulants, and low-dose thrombolytics. Clinical discussion: Management of massive pulmonary thromboembolism includes medical thrombolysis along with maintenance of hemodynamic stability. Our patient was successfully managed with low-dose thrombolytics and was continued with standard oral anticoagulants for 6 months. Conclusion: In patients of acute massive pulmonary thromboembolism, a low dose of the thrombolytic agent can achieve complete resolution of the thrombus with less bleeding risk. HIGHLIGHTS Acute massive pulmonary thromboembolism is a life-threatening condition requiring urgent diagnosis and management. Management of massive pulmonary thromboembolism includes hemodynamic stability and medical thrombolysis. Successful thrombolysis can be achieved with low-dose thrombolytics in patients with higher risk of bleeding complications.
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Adhikari et al. (2022) studied this question.
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