Dilemma of Thrombolysis in a patient with high-risk Pulmonary Embolism with severe Thrombocytopenia: A case report.

Autor:	Iqbal P; Department of Internal Medicine, New York Medical College/Metropolitan Hospital Center, New York, USA., Habib MB; Department of Internal Medicine, Hamad Medical Corporation, Qatar Email: MAbubakar@hamad.qa., Hatim A; Department of Internal Medicine, Hamad Medical Corporation, Qatar Email: MAbubakar@hamad.qa., Alkhatib M; Department of Internal Medicine, Hamad Medical Corporation, Qatar Email: MAbubakar@hamad.qa., Bakar MA; Department of Internal Medicine, Hamad Medical Corporation, Qatar Email: MAbubakar@hamad.qa., Koya SH; Department of Medical ICU, Hamad Medical Corporation, Qatar., Alshurafa A; Department of Hematology, Hamad Medical Corporation, Qatar., Rehman HU; Department of Medical ICU, Hamad Medical Corporation, Qatar.
Jazyk:	angličtina
Zdroj:	Qatar medical journal [Qatar Med J] 2024 Jan 13; Vol. 2023 (4), pp. 39. Date of Electronic Publication: 2024 Jan 13 (Print Publication: 2023).
DOI:	10.5339/qmj.2023.39
Abstrakt:	Background: Managing a high-risk pulmonary embolism (PE) in a critically ill patient with severe thrombocytopenia can present a challenging dilemma. There is a high risk of fatal bleeding due to anticoagulation in high-risk PE with thrombocytopenia; therefore, risks and benefits are balanced while dealing with such a critical scenario. Case Report: We present a case of a female patient with thrombocytopenia who was admitted for management of lymphoma. Her hospital course was complicated by high-risk PE, leading to acute respiratory failure and hypotension, necessitating urgent transfer to the medical intensive care unit. She was intubated and placed on mechanical ventilation. Multiple cardiac arrests occurred due to compromised cardiac output from a severely dilated right ventricle on bedside transthoracic echocardiography. As a last resort to save her life in this critical state and severe thrombocytopenia, she was given a half bolus dose of the recommended drug, i.e., 50mg IV of Alteplase. Subsequently, she stabilized and was extubated without any further complications. Discussion: High-risk PE needs prompt management with anticoagulation to avoid fatal outcomes. However, on the other hand, anticoagulation carries a high risk of bleeding, especially in patients with thrombocytopenia. These challenges prompt a modern perspective in situations where clear guidelines are absent. Conclusion: We aim to discuss our contemporary clinical practice in managing such a complex case and highlight the need for further studies. Competing Interests: The authors certify that they have no conflict of interest or affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript. (© 2023 Iqbal, Habib, Hatim, Alkhatib, Bakar, Koya, Alshurafa, Rehman, Licensee HBKU Press.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu