Kivanc KARAMAN, Cihangir CELİK, Alten OSKAY, Hamit Hakan ARMAĞAN, Onder TOMRUK

SUCCESSFUL TREATMENT OF PULMONARY EMBOLISM AND ASSOCIATED UPPER EXTREMITY ARTERY THROMBOSIS USING INTRAVENOUS ALTEPLASE: A CASE REPORT

Introduction: Although thrombolytic administration is inevitable in the management of massive pulmonary embolism, contradictions exist in the treatment of sub-massive pulmonary embolism. There are drawbacks to thrombolytic treatment due to potential serious side effects such as cranial hemorrhage. Case Report: An 84-year-old female patient was admitted to the emergency service because of pain and lack of a pulse in her right arm and %61 oxygen saturation without any respiratory system complaints. A computerized tomography showed pulmonary embolism close to totality in the bilateral main pulmonary arteries and peripheral embolism in the right brachial artery. We considered a sub-massive pulmonary embolism in this patient with no hypotension despite bilateral pulmonary artery embolism, good general condition, but a dilated right ventriculi in transthoracic echocardiography. Since the PESI score was 115, it was decided that the patient was in the high-risk group. After administration of 100 mg Alteplase as thrombolytic therapy, her oxygen saturation increased to 95% in the room air and her complaint of right arm completely regressed. Furthermore, none of the possible complications from thrombolytic therapy, such as fatal bleeding, were observed in our patient. Conclusion: In this article, it is emphasized that thrombolytic therapy is an appropriate choice for patients with sub-massive pulmonary embolism and acute arterial embolism.

Keywords:

Emergency service, Peripheral arterial embolism, Pulmonary embolism,

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1. Teleb M, Porres-Aguilar M, Anaya-Ayala JE, Rodriguez-Castro C, Porres-Muñoz M, Mukherjee D. Potential role of systemic thrombolysis in acute submassive intermediate risk pulmonary embolism: review and future perspective. Ther Adv Cardiovasc Dis 2016; 10(2): 103–10.
2. Long B, Koyfman A. Current Controversies In Thrombolytic Use In Acute Pulmonary Embolism. The Journal of Emergency Medicine 2016; 51(1): 37–44.
3. Baile´n MR, Cuadra JA, Aguayo De Hoyos E. Thrombolysis During Cardiopulmonary Resuscitation In Fulminant Pulmonary Embolism: A Review. Crit Care Med 2001; 29: 2211–9.
4. Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002; 347: 1143–50.
5. Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M. Moderate pulmonary embolism treated with thrombolysis (from the MOPETT trial). Am J Cardiol 2013; 111: 273–7.
6. Gao G, Yang P, Liu M, Din M, Liu G, Tong Y, et al. Thrombolysis for acute intermediaterisk pulmonary embolism: a meta-analysis. Thromb Res 2015; 136: 932–7.
7. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149: 315-52.
8. Van der Hulle T, Kooiman J, Den Exter PL, Dekkers OM, Klok FA, Huisman MV. Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis. J Thromb Haemost 2014; 12(3): 320-8.
9. Christine GK, Gregory JF, William FP, Phil SW, Christopher WB, Veronica A, et al. Association between rivaroxaban use and length of hospital stay, treatment costs and early outcomes in patients with pulmonary embolism:a systematic review of real-world studies. Current Medical Research and Opinion 2017; 33(9): 1697-703.
10. Işık GC, Çorbacıoğlu SK, Cevik Y. Watershed Infarct due to Massive Pulmonary Embolism: A Rare Diagnosis at the Emergency Department. JEMCR 2016; 7: 34-6.
11. Zhang HL, Liu ZH, Luo Q, Wang Y, Zhao ZH, Xiong CM. Paradoxical embolism: Experiences from a single center. Chronic Diseases and Translational Medicine 2017; 3: 123-8.

Journal of Emergency Medicine Case Reports-Cover

Başlangıç: 2010
Yayıncı: Alpay Azap

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