Vol 74, Supp. III (2016)
Case studies
Published online: 2016-06-03

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Double thrombolysis in early pregnancy can be safe

Anna Kania, Janusz Kudlicki, Agata Frania-Baryluk, Michał Trojnar, Magdalena Guła, Karolina Parcheta, Andrzej Wysokiński, Elżbieta Czekajska-Chehab, Piotr Adamczyk, Anna Drelich-Zbroja

Abstract

We describe the case of pregnant patient with diagnosed massive pulmonary embolism, who underwent successful double thrombolysis. A 23-year-old woman in the 7th week of her 3rd pregnancy was admitted to the Intensive Cardiac Care Unit 2 h after sudden onset of chest pain and dyspnoea. An immediate electrocardiography showed sinus tachycardia with typical S1Q3T3 pattern and rsr’ complex in lead V1. Transthoracic echocardiography on admission revealed right ventricular strain. We performed emergent computed tomography angiography of the chest, which showed significant thrombus in both pulmonary arteries, resulting in restricted blood flow. The patient was treated with unfractionated heparin infusion, monitored by activated partial thromboplastin time. Because of her deteriorating condition, we administered alteplase (10 mg bolus, then 90 mg over the next 2 h). Ultrasonography examination of her pelvis and lower extremities revealed spindle-shaped thrombus of the right common iliac and external iliac veins. On her 10th day of hospitalisation, during the patient’s mobilisation, she presented with symptoms of shock. She needed endotracheal intubation, mechanical ventilation and vasoconstrictor support. We treated her with a second round of full dose alteplase. No complications further developed for the mother or foetus in the subsequent days. She gave birth to a healthy son weighing 3580 g with Apgar score of 10 points in her 38th week of pregnancy by natural delivery. After delivery we switched low molecular weight heparin to warfarin according to her international normalised ratio. In conclusion, double thrombolysis in early pregnancy proved to be safe for both the mother and child, but additional studies need to be performed.

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Polish Heart Journal (Kardiologia Polska)