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Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis

2019Journal article Open access
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dc.contributor.authorMarinho, Ricardo Cleto
dc.contributor.authorMartins, J.
dc.contributor.authorCosta, S.
dc.contributor.authorBaptista, R.
dc.contributor.authorGonçalves, L.
dc.contributor.authorFranco, F.
dc.date.accessioned2020-05-12T09:08:42Z
dc.date.available2020-05-12T09:08:42Z
dc.date.issued2019
dc.description.abstractBackground: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationMarinho 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_001150pt_PT
dc.identifier.doi10.12890/2019_001150pt_PT
dc.identifier.issn2284-2594
dc.identifier.urihttp://hdl.handle.net/10400.16/2376
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSMC Mediapt_PT
dc.relation.publisherversionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6663048/pdf/150-1-8507-1-10-20190710.pdfpt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/pt_PT
dc.subjectPulmonary embolismpt_PT
dc.subjectalteplasept_PT
dc.subjectpericardial effusionpt_PT
dc.subjectpericardiocentesispt_PT
dc.subjectthrombolytic therapypt_PT
dc.titleAlteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceItalypt_PT
oaire.citation.issue7pt_PT
oaire.citation.startPage001150pt_PT
oaire.citation.titleEuropean journal of case reports in internal medicinept_PT
oaire.citation.volume6pt_PT
person.familyNameMarinho
person.givenNameRicardo Cleto
person.identifier.orcid0000-0001-7091-3911
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationb46f9e83-d0bd-4ca2-8e52-44ca2f786eac
relation.isAuthorOfPublication.latestForDiscoveryb46f9e83-d0bd-4ca2-8e52-44ca2f786eac

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