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Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida: A case report

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 p...

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Autores principales: Liao, Jiyang, Lai, Fang, Xie, Dongping, Han, Yun, Mai, Shutao, Weng, Yanna, Zhang, Yan, Du, Jiongdong, Zhou, Gengbiao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221663/
https://www.ncbi.nlm.nih.gov/pubmed/30412129
http://dx.doi.org/10.1097/MD.0000000000012985
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author Liao, Jiyang
Lai, Fang
Xie, Dongping
Han, Yun
Mai, Shutao
Weng, Yanna
Zhang, Yan
Du, Jiongdong
Zhou, Gengbiao
author_facet Liao, Jiyang
Lai, Fang
Xie, Dongping
Han, Yun
Mai, Shutao
Weng, Yanna
Zhang, Yan
Du, Jiongdong
Zhou, Gengbiao
author_sort Liao, Jiyang
collection PubMed
description 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.
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spelling pubmed-62216632018-12-04 Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida: A case report Liao, Jiyang Lai, Fang Xie, Dongping Han, Yun Mai, Shutao Weng, Yanna Zhang, Yan Du, Jiongdong Zhou, Gengbiao Medicine (Baltimore) Research Article 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. Wolters Kluwer Health 2018-10-26 /pmc/articles/PMC6221663/ /pubmed/30412129 http://dx.doi.org/10.1097/MD.0000000000012985 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle Research Article
Liao, Jiyang
Lai, Fang
Xie, Dongping
Han, Yun
Mai, Shutao
Weng, Yanna
Zhang, Yan
Du, Jiongdong
Zhou, Gengbiao
Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida: A case report
title Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida: A case report
title_full Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida: A case report
title_fullStr Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida: A case report
title_full_unstemmed Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida: A case report
title_short Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida: A case report
title_sort successful low-dosage thrombolysis of massive pulmonary embolism in primigravida: a case report
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221663/
https://www.ncbi.nlm.nih.gov/pubmed/30412129
http://dx.doi.org/10.1097/MD.0000000000012985
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