Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis

Detalhes bibliográficos
Autor(a) principal: Marinho, Ricardo Cleto
Data de Publicação: 2019
Outros Autores: Martins, J., Costa, S., Baptista, R., Gonçalves, L., Franco, F.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.16/2376
Resumo: Background: The occurrence of a high-risk pulmonary embolism (PE) within 48 hours of a complicated pericardiocentesis to remove a haemorrhagic pericardial effusion, is an uncommon clinical challenge. Case summary: The authors report the case of a 75-year-old woman who presented with signs of imminent cardiac tamponade due to recurring idiopathic pericardial effusion. The patient underwent pericardiocentesis that was complicated by the loss of 1.5 litres of blood. Within 48 hours, the patient had collapsed with clear signs of obstructive shock. This was a life-threating situation so alteplase was administered after cardiac tamponade and hypertensive pneumothorax had been excluded. CT chest angiography later confirmed bilateral PE. The patient achieved haemodynamic stability less than an hour after receiving the alteplase. However, due to the high risk of bleeding, the medical team suspended the thrombolysis protocol and switched to unfractionated heparin within the hour. The cause of the PE was not identified despite extensive study, but after 1 year of follow-up the patient remained asymptomatic. Discussion: Despite the presence of a contraindication, the use of thrombolytic therapy in obstructive shock after exclusion of hypertensive pneumothorax can be life-saving, and low-dose thrombolytic therapy may be a valid option in such cases. Learning points: A quick and systematic approach to a collapsed patient with signs of shock is mandatory; understanding the type of shock may help narrow the differential diagnosis and help in therapeutic decisions.After exclusion of cardiac tamponade and hypertensive pneumothorax, life-saving thrombolytic therapy can be administered in obstructive shock due to probable massive pulmonary embolism.Contraindications for thrombolytic therapy originated as exclusion criteria for clinical trials but should not prevent the use of this therapy in life-threatening situations.
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spelling Alteplase for Massive Pulmonary Embolism after Complicated PericardiocentesisPulmonary embolismalteplasepericardial effusionpericardiocentesisthrombolytic therapyBackground: The occurrence of a high-risk pulmonary embolism (PE) within 48 hours of a complicated pericardiocentesis to remove a haemorrhagic pericardial effusion, is an uncommon clinical challenge. Case summary: The authors report the case of a 75-year-old woman who presented with signs of imminent cardiac tamponade due to recurring idiopathic pericardial effusion. The patient underwent pericardiocentesis that was complicated by the loss of 1.5 litres of blood. Within 48 hours, the patient had collapsed with clear signs of obstructive shock. This was a life-threating situation so alteplase was administered after cardiac tamponade and hypertensive pneumothorax had been excluded. CT chest angiography later confirmed bilateral PE. The patient achieved haemodynamic stability less than an hour after receiving the alteplase. However, due to the high risk of bleeding, the medical team suspended the thrombolysis protocol and switched to unfractionated heparin within the hour. The cause of the PE was not identified despite extensive study, but after 1 year of follow-up the patient remained asymptomatic. Discussion: Despite the presence of a contraindication, the use of thrombolytic therapy in obstructive shock after exclusion of hypertensive pneumothorax can be life-saving, and low-dose thrombolytic therapy may be a valid option in such cases. Learning points: A quick and systematic approach to a collapsed patient with signs of shock is mandatory; understanding the type of shock may help narrow the differential diagnosis and help in therapeutic decisions.After exclusion of cardiac tamponade and hypertensive pneumothorax, life-saving thrombolytic therapy can be administered in obstructive shock due to probable massive pulmonary embolism.Contraindications for thrombolytic therapy originated as exclusion criteria for clinical trials but should not prevent the use of this therapy in life-threatening situations.SMC MediaRepositório Científico do Centro Hospitalar Universitário de Santo AntónioMarinho, Ricardo CletoMartins, J.Costa, S.Baptista, R.Gonçalves, L.Franco, F.2020-05-12T09:08:42Z20192019-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.16/2376engMarinho RC, Martins JL, Costa S, Baptista R, Gonçalves L, Franco F. Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis. Eur J Case Rep Intern Med. 2019;6(7):001150. Published 2019 Jul 15. doi:10.12890/2019_0011502284-259410.12890/2019_001150info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-10-20T11:00:30Zoai:repositorio.chporto.pt:10400.16/2376Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:38:34.792969Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis
title Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis
spellingShingle Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis
Marinho, Ricardo Cleto
Pulmonary embolism
alteplase
pericardial effusion
pericardiocentesis
thrombolytic therapy
title_short Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis
title_full Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis
title_fullStr Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis
title_full_unstemmed Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis
title_sort Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis
author Marinho, Ricardo Cleto
author_facet Marinho, Ricardo Cleto
Martins, J.
Costa, S.
Baptista, R.
Gonçalves, L.
Franco, F.
author_role author
author2 Martins, J.
Costa, S.
Baptista, R.
Gonçalves, L.
Franco, F.
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório Científico do Centro Hospitalar Universitário de Santo António
dc.contributor.author.fl_str_mv Marinho, Ricardo Cleto
Martins, J.
Costa, S.
Baptista, R.
Gonçalves, L.
Franco, F.
dc.subject.por.fl_str_mv Pulmonary embolism
alteplase
pericardial effusion
pericardiocentesis
thrombolytic therapy
topic Pulmonary embolism
alteplase
pericardial effusion
pericardiocentesis
thrombolytic therapy
description Background: The occurrence of a high-risk pulmonary embolism (PE) within 48 hours of a complicated pericardiocentesis to remove a haemorrhagic pericardial effusion, is an uncommon clinical challenge. Case summary: The authors report the case of a 75-year-old woman who presented with signs of imminent cardiac tamponade due to recurring idiopathic pericardial effusion. The patient underwent pericardiocentesis that was complicated by the loss of 1.5 litres of blood. Within 48 hours, the patient had collapsed with clear signs of obstructive shock. This was a life-threating situation so alteplase was administered after cardiac tamponade and hypertensive pneumothorax had been excluded. CT chest angiography later confirmed bilateral PE. The patient achieved haemodynamic stability less than an hour after receiving the alteplase. However, due to the high risk of bleeding, the medical team suspended the thrombolysis protocol and switched to unfractionated heparin within the hour. The cause of the PE was not identified despite extensive study, but after 1 year of follow-up the patient remained asymptomatic. Discussion: Despite the presence of a contraindication, the use of thrombolytic therapy in obstructive shock after exclusion of hypertensive pneumothorax can be life-saving, and low-dose thrombolytic therapy may be a valid option in such cases. Learning points: A quick and systematic approach to a collapsed patient with signs of shock is mandatory; understanding the type of shock may help narrow the differential diagnosis and help in therapeutic decisions.After exclusion of cardiac tamponade and hypertensive pneumothorax, life-saving thrombolytic therapy can be administered in obstructive shock due to probable massive pulmonary embolism.Contraindications for thrombolytic therapy originated as exclusion criteria for clinical trials but should not prevent the use of this therapy in life-threatening situations.
publishDate 2019
dc.date.none.fl_str_mv 2019
2019-01-01T00:00:00Z
2020-05-12T09:08:42Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.16/2376
url http://hdl.handle.net/10400.16/2376
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Marinho RC, Martins JL, Costa S, Baptista R, Gonçalves L, Franco F. Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis. Eur J Case Rep Intern Med. 2019;6(7):001150. Published 2019 Jul 15. doi:10.12890/2019_001150
2284-2594
10.12890/2019_001150
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv SMC Media
publisher.none.fl_str_mv SMC Media
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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