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Rescue thrombolysis partial failure in massive PE complicated with in-transit thrombus
A 58-year-old man who presented with syncope, dyspnea, and hemodynamic compromise was found to have large free-floating right atrial thrombuses on echocardiogram. Decision was made to transfer the patient for emergent atriotomy. Cardiothoracic surgeons declared the patient as inoperable and recommen...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330970/ https://www.ncbi.nlm.nih.gov/pubmed/30666168 http://dx.doi.org/10.2147/IMCRJ.S189944 |
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author | Alirezaei, Toktam Aval, Zahra Ansari |
author_facet | Alirezaei, Toktam Aval, Zahra Ansari |
author_sort | Alirezaei, Toktam |
collection | PubMed |
description | A 58-year-old man who presented with syncope, dyspnea, and hemodynamic compromise was found to have large free-floating right atrial thrombuses on echocardiogram. Decision was made to transfer the patient for emergent atriotomy. Cardiothoracic surgeons declared the patient as inoperable and recommended to use a lytic agent. Alteplase was administered with subsequent near-complete resolution of symptoms and near-normalization of echocardio-graphic parameters. The post-thrombolytic course was complicated by saddle pulmonary emboli requiring embolectomy. Catheter embolectomy was not available and cardiothoracic surgeon in other center considered the patient to be very high risk for transferring between hospitals and surgical intervention. Ultimately, the critical decision was made, despite the patient having been administered thrombolytic therapy within the previous 48 hours. Alteplase was given, but was not effective and the patient required surgical intervention. Surgical embolectomy was done successfully in another hospital and the patient was discharged with warfarin. |
format | Online Article Text |
id | pubmed-6330970 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-63309702019-01-21 Rescue thrombolysis partial failure in massive PE complicated with in-transit thrombus Alirezaei, Toktam Aval, Zahra Ansari Int Med Case Rep J Case Report A 58-year-old man who presented with syncope, dyspnea, and hemodynamic compromise was found to have large free-floating right atrial thrombuses on echocardiogram. Decision was made to transfer the patient for emergent atriotomy. Cardiothoracic surgeons declared the patient as inoperable and recommended to use a lytic agent. Alteplase was administered with subsequent near-complete resolution of symptoms and near-normalization of echocardio-graphic parameters. The post-thrombolytic course was complicated by saddle pulmonary emboli requiring embolectomy. Catheter embolectomy was not available and cardiothoracic surgeon in other center considered the patient to be very high risk for transferring between hospitals and surgical intervention. Ultimately, the critical decision was made, despite the patient having been administered thrombolytic therapy within the previous 48 hours. Alteplase was given, but was not effective and the patient required surgical intervention. Surgical embolectomy was done successfully in another hospital and the patient was discharged with warfarin. Dove Medical Press 2019-01-09 /pmc/articles/PMC6330970/ /pubmed/30666168 http://dx.doi.org/10.2147/IMCRJ.S189944 Text en © 2019 Alirezaei and Ansari Aval. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For |
spellingShingle | Case Report Alirezaei, Toktam Aval, Zahra Ansari Rescue thrombolysis partial failure in massive PE complicated with in-transit thrombus |
title | Rescue thrombolysis partial failure in massive PE complicated with in-transit thrombus |
title_full | Rescue thrombolysis partial failure in massive PE complicated with in-transit thrombus |
title_fullStr | Rescue thrombolysis partial failure in massive PE complicated with in-transit thrombus |
title_full_unstemmed | Rescue thrombolysis partial failure in massive PE complicated with in-transit thrombus |
title_short | Rescue thrombolysis partial failure in massive PE complicated with in-transit thrombus |
title_sort | rescue thrombolysis partial failure in massive pe complicated with in-transit thrombus |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330970/ https://www.ncbi.nlm.nih.gov/pubmed/30666168 http://dx.doi.org/10.2147/IMCRJ.S189944 |
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