Key result
Administration of tenecteplase successfully treated a massive pulmonary embolism and right heart thrombi, leading to hemodynamic improvement and complete resolution of the thrombi despite an absolute contraindication.
Why the study?
Massive pulmonary embolism combined with right atrial thrombus carries high mortality and risk of hemodynamic collapse, but the use of fibrinolytic therapy can be lifesaving despite contraindications.
Case Report (n=1)
Tenecteplase can be a lifesaving last-resort treatment for massive pulmonary embolism with right heart thrombi even when absolute contraindications exist and surgical/catheter options are unavailable.
May warrant last-resort consideration in contraindicated massive PE; leaves open need for prospective trials.
Massive pulmonary embolism (PE) combined with right atrial (RA) thrombus is associated with significant mortality. Hemodynamic collapses, which can manifest as hypotension, severe dyspnea; cyanosis, syncope, shock, and right ventricular heart failure are the hallmark of massive PE. Moreover, hemodynamic collapse can be the earliest clinical presentation and the most common cause of death in the first days. Although fibrinolytic therapy has contraindications; exclusion is necessary to minimize bleeding risk, but it can be lifesaving and prevent complications such as shock, right ventricular heart failure, and multi-system organ failure. Here, we report a 70-year-old woman who has an atypical presentation of sudden onset of a persistent hiccup for 8 hours diagnosed with massive pulmonary embolism with multiple free floating thromboses in the right atrial and right ventricle which has been successfully treated with systemic fibrinolytic. Furthermore, the patient was given a Tenecteplase as a last resort to save her life due to the unavailability of the catheter or surgical embolectomy besides an absolute contraindication for thrombolytic.
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Mohamud et al. (2022) conducted a case report in Massive pulmonary embolism with multiple free-floating thromboses in the right atrium and right ventricle (n=1). Tenecteplase was evaluated on Clinical and hemodynamic improvement, resolution of thrombus. Administration of tenecteplase successfully treated a massive pulmonary embolism and right heart thrombi, leading to hemodynamic improvement and complete resolution of the thrombi despite an absolute contraindication.
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