Successful Treatment of Refractory Massive Pulmonary Embolism with Repeated Administration of Systemic Thrombolysis

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Poor Armeen D.; Poor Hooman D.

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Journal: TANAFFOS Year:2018 | Volume:17 | Issue:2 Page(s): 127-131

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Title

Successful Treatment of Refractory Massive Pulmonary Embolism with Repeated Administration of Systemic Thrombolysis

Author(s)

Poor Armeen D. | Poor Hooman D. | Issue Writer Certificate

Keywords

Acute pulmonary hypertension

Alteplase

Massive pulmonary embolism

Obstructive shock

Right ventricular failure

Systemic thrombolysis

Abstract

Background: We report a case series of two patients in the intensive care unit with Massive pulmonary embolism and Obstructive shock who had resolution of shock after repeated administration of Alteplase. Case Summaries: Both patients were initially dosed 10 mg of Alteplase followed by infusion of 90 mg over 2 hours, but remained in Obstructive shock requiring significant inotropic and vasopressor support. Both patients were deemed poor candidates for embolectomy. The first patient received repeated doses reaching an accumulative dose of 200 mg Alteplase over 15 hours. The second patient received an accumulative dose of 250 mg Alteplase over 36 hours. Both patients had resolution of shock within 24 hours of repeated administration of Alteplase, but also experienced significant drops in hemoglobin, which were supported with transfusions. They were transferred out of the intensive care unit after resolution of Obstructive shock and hemorrhage. The first patient died one week after transfer from the intensive care unit due to invasive candidiasis and septic shock. The second patient was weaned from the ventilator and discharged home. Conclusion: Patients with Obstructive shock secondary to Massive pulmonary embolism despite a one-time dose of Alteplase and poor candidacy for embolectomy may benefit from repeated doses of Alteplase. Due to the short half-life, repeated administration of thrombolytic may be appropriate for younger patients without absolute contraindications to thrombolysis, but future studies are needed to identify the optimal patient population.

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APA: Copy

Poor, Armeen D., & Poor, Hooman D.. (2018). Successful Treatment of Refractory Massive Pulmonary Embolism with Repeated Administration of Systemic Thrombolysis. TANAFFOS, 17(2), 127-131. SID. https://sid.ir/paper/715772/en

Vancouver: Copy

Poor Armeen D., Poor Hooman D.. Successful Treatment of Refractory Massive Pulmonary Embolism with Repeated Administration of Systemic Thrombolysis. TANAFFOS[Internet]. 2018;17(2):127-131. Available from: https://sid.ir/paper/715772/en

IEEE: Copy

Armeen D. Poor, and Hooman D. Poor, “Successful Treatment of Refractory Massive Pulmonary Embolism with Repeated Administration of Systemic Thrombolysis,” TANAFFOS, vol. 17, no. 2, pp. 127–131, 2018, [Online]. Available: https://sid.ir/paper/715772/en

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