Massive Fatal Pulmonary Embolism While on Therapeutic Heparin Drip

Abstract

Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE). In this article, we present a case of a patient with an acute DVT who was treated with a therapeutic heparin drip, then developed syncope while in the hospital and found to have massive bilateral PEs. This case aims to arouse the medical staff’s awareness of the VTE diagnosis even if the patient is fully anticoagulated. We review the indications for DVT hospitalization, heparin infusion monitoring, risk factors for developing PE from DVT, mechanisms of developing PE from DVT while on therapeutic anticoagulation, and signs and treatment of massive PE.

A Closed-Loop Audit of Thrombo-Embolic Deterrent Stocking Use in an Orthopaedic Ward.

“…VTE is the most common preventable cause of postoperative death [16]. Death due to PE occurs within a few hours after the onset of symptoms with a mortality rate of 15.2% if the patient presents with arterial hypotension, 24.5% if the patient is in cardiogenic shock, and 90% in cardiac arrestrelated PE, even with thrombolysis [17]. According to a systematic review by Kakkos et al (2022), combining mechanical and pharmacological thromboprophylaxis modalities had a lower incidence of DVT than mechanical thromboprophylaxis methods alone (2.03% versus 3.81%; p = 0.0001) [16].…”