Pharmacological Management of Saddle Pulmonary Embolism in a High-Risk Patient With COVID-19

Abstract

A pulmonary embolism (PE) that is located in the main pulmonary artery is known as a saddle pulmonary embolism. Individuals at high risk who become unstable often require surgical intervention or more aggressive management with thrombolytic therapy. COVID-19 is a known risk factor for a hypercoagulable state and therefore increases the risk of PE and its associated complications. Individuals hospitalized with the COVID-19 virus and who have evidence of right ventricular dysfunction with PE are found to have a significantly higher risk of mortality. We present a case of an individual with several high-risk factors for PE as well as COVID-19 infection and evidence of cardiac strain, making the decision for treatment less clear. He was, however, treated successfully with heparin and enoxaparin alone. Furthermore, our case had resolving symptoms of COVID-19, highlighting the importance of high clinical suspicion for PE in those diagnosed with COVID-19.

Case Report of Pulmonary Embolism with Right Ventricular Strain in a Young Female

“…The patient's BNP and troponin levels correlated with right ventricular strain. Patients with RV strain or instability benefit from systemic thrombolytics or mechanical thrombectomy [6]. The patient was managed with a heparin drip and then transferred to a tertiary center for the saddle pulmonary embolus thrombectomy.…”