Bronchial artery embolization followed by anticoagulation in patients with concurrent hemoptysis and pulmonary embolism: a case series and narrative literature review

Background The management of concurrent hemoptysis and pulmonary embolism (PE) is challenging because bleeding control and anticoagulation require competing treatment priorities. No clear consensus exists on how to balance these risks. We report nine cases from two centers and review previously published cases to describe the clinical course of patients managed with bleeding control followed by individualized anticoagulation. Case presentation Between September 2024 and February 2026, 22 patients presenting with concurrent hemoptysis and objectively confirmed PE were identified at two tertiary-care hospitals. The eligibility criteria for inclusion in the present case series were established before detailed retrospective data extraction. Of the 13 patients who were not included, five were discharged against medical advice or transferred to another institution and could not be adequately followed, two died, four received medical hemostatic treatment followed by anticoagulation without BAE, and two received anticoagulation directly without BAE. Nine patients fulfilled the predefined eligibility criteria: active hemoptysis requiring bronchial artery embolization (BAE), PE confirmed by computed tomography pulmonary angiography (CTPA), initiation of anticoagulation after BAE, and availability of complete clinical and follow-up data. Patients managed without BAE, those who could not receive anticoagulation after haemostasis, and individuals with incomplete clinical or follow-up data were excluded from the study. The nine patients comprised six men and three women, with ages ranging from 52 to 84 years. All patients underwent BAE to achieve hemostasis, followed by individualized anticoagulation initiated 1-10 days after the procedure. Hemoptysis was controlled in all patients. During the 6- month follow-up period, no recurrent hemoptysis or clinically evident recurrent venous thromboembolic events were observed. Conclusions BAE followed by individualized anticoagulation may represent a potentially feasible strategy for carefully selected, hemodynamically stable patients with concurrent hemoptysis and PE. The timing of anticoagulation should be individualized based on hemostasis, clinical status, and thrombotic risk. These findings are preliminary and cannot be interpreted as establishing the safety or efficacy of this approach. Clinical trial number Not applicable.