Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida
| Autor: | Gengbiao Zhou, Shutao Mai, Yanna Weng, Yan Zhang, Yun Han, Fang Lai, Jiongdong Du, Dong-ping Xie, Jiyang Liao |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Pregnancy
Exacerbation business.industry medicine.medical_treatment General Medicine Emergency department Thrombolysis 030204 cardiovascular system & hematology Abortion Hypoxia (medical) medicine.disease Intensive care unit Pulmonary embolism law.invention 03 medical and health sciences 0302 clinical medicine law Anesthesia medicine 030212 general & internal medicine medicine.symptom business |
| Zdroj: | Medicine. 97:e12985 |
| ISSN: | 1536-5964 0025-7974 |
| Popis: | Rational Thrombolysis in primigravida with hemodynamic instability is controversial, especially treatment with low-dosage recombinant tissue plasminogen activator (rtPA), and related studies are extremely rare. Here, we report the case of a 26-year-old primigravida diagnosed with an acute massive pulmonary embolism (PE) that prompted initiation of thrombolysis with low-dose alteplase. Patient concerns The patient was admitted to the Emergency Department with chief complaints of a sudden onset of extremely dyspnea, chest tightness, and confusion over a 6-hour period. She was found to have significant dilation of her right ventricle, moderate pulmonary arterial hypotension, as shown by transthoracic echocardiography, and a typical S1-Q3-T3 pattern, as shown by electrocardiogram (ECG). Diagnosis Acute massive PE in primigravida. Intervention The patient underwent intravenous thrombolysis with a half dose of alteplase. Outcomes The fetus lived through this severe event during the mother's stay in the Intensive Care Unit; however, surgical abortion was unexpectedly proposed due to long-term hypoxia and high-risk of relapse and exacerbation and was performed successfully after the agreement of her kin. The patient recovered gradually, and results of her laboratory tests and postsurgical, repeated contrast-enhanced computed tomography had normalized by her 3-month follow-up. Lessons Administration of low-dosage alteplase in primigravida with hemodynamic instability is extremely rare and controversial; however, our case suggests that this treatment strategy is relatively safe and feasible. In addition, nonradiometric examination played a major role in the diagnosis of PE in this patient. Because radiation use is contraindicated during pregnancy, these examinations could be the first choice for pregnant patients with suspected PE. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|