Successful thrombolysis of massive PE in a primigravida
Thrombolysis in primigravida with hemodynamic instability is controversial, especially treatment with low-dosage recombinant tissue plasminogen activator (rtPA), and related studies are extremely rare.

Published in the journal Medicine, the authors report the case of a 26-year-old primigravida diagnosed with an acute massive pulmonary embolism (PE) that prompted initiation of thrombolysis with low-dose alteplase.

The patient was admitted to the Emergency Department with chief complaints of a sudden onset of extremely dyspnea, chest tightness, and confusion over a 6-hour period. She was found to have significant dilation of her right ventricle, moderate pulmonary arterial hypotension and a typical S1-Q3-T3 pattern.

The patient underwent intravenous thrombolysis with a half dose of alteplase. The fetus lived through this severe event during the mother's stay in the ICU; however, surgical abortion was unexpectedly proposed due to long-term hypoxia and high-risk of relapse and exacerbation and was performed successfully after the agreement of her kin.

The patient recovered gradually, and results of her laboratory tests and postsurgical, repeated contrast-enhanced computed tomography had normalized by her 3-month follow-up.

Major takeaway:-
- Administration of low-dosage alteplase in primigravida with hemodynamic instability is extremely rare and controversial; however, this case suggests that this treatment strategy is relatively safe and feasible.

- In addition, nonradiometric examination played a major role in the diagnosis of PE in this patient. Because radiation use is contraindicated during pregnancy, these examinations could be the first choice for pregnant patients with suspected PE.

Read in detail here: https://pxmd.co/XGPqf
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