Key result
Systemic fibrinolytic therapy was successfully administered to three patients with massive pulmonary embolism and absolute contraindications, resulting in clinical improvement and hospital discharge without hemorrhagic complications.
Why the study?
Does systemic fibrinolytic therapy improve outcomes in patients with massive pulmonary embolism and absolute contraindications when other treatments are unavailable?
Case Report (n=3)
No
Does systemic fibrinolytic therapy improve outcomes in patients with massive pulmonary embolism and absolute contraindications when other treatments are unavailable?
Systemic fibrinolytic therapy may be considered as a lifesaving measure in massive PE patients with absolute contraindications when surgical or catheter embolectomy are unavailable and transfer is too high risk.
May support rescue use of systemic fibrinolysis in massive PE with absolute contraindications when alternatives unavailable; hypothesis-generating, leaves practice change open.
In massive pulmonary embolism (PE), fibrinolytic therapy is a potential lifesaving treatment; therefore, if other treatments are not available, the physicians encounter this question: can we accept the risk of complications from fibrinolytic therapy, especially intracranial hemorrhage, in the presence of absolute contraindication, in order to save the patient's life? Here, we describe three cases of massive PE with absolute contraindication for fibrinolytic therapy who presented to emergency department following dyspnea. Since, surgical or catheter embolectomy were not available and patients were very high risk for transferring to another hospital, systemic fibrinolytic was administered. The patients improved clinically and were discharged from hospital. It seems that, if no other acceptable treatments are available, physicians could consider fibrinolytic therapy, even at the presence of contraindication, to save the patient's life.
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Pishgahi et al. (2018) conducted a case report in Massive pulmonary embolism (n=3). Systemic fibrinolytic therapy (Alteplase) was evaluated on Clinical improvement and survival to discharge without major bleeding complications. Systemic fibrinolytic therapy was successfully administered to three patients with massive pulmonary embolism and absolute contraindications, resulting in clinical improvement and hospital discharge without hemorrhagic complications.
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