Thrombolysis for the management of massive pulmonary embolism in pregnancy

Tawfik, Mona K.; Taman, M.E.; Motawea, A.A.; Abdel-Hady, El-Said

doi:10.1016/j.ijoa.2012.12.010

Cited by 15 publications

(11 citation statements)

References 24 publications

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“…Although heparin can be safely used for PE during pregnancy, use of thrombolytic agents for PE complicated by shock or hypotension during pregnancy is highly controversial due to the risk of bleeding complications and miscarriage . According to recent published works, 19 cases of successful maternal treatment using rtPA have been reported, with complicating fetal death in one case and a minor bleeding episode in another . Our case required an additional dose of monteplase for refractory shock with persisting right ventricular dilatation 30 min after the initial dose.…”

Section: Discussionmentioning

confidence: 85%

Successful treatment of pulmonary embolism‐induced cardiac arrest by thrombolysis and targeted temperature management during pregnancy

Oami

Oshima

Oku

et al. 2018

Acute Medicine & Surgery

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BackgroundThrombolysis for pulmonary embolism and targeted temperature management for cardiac arrest are controversial treatments in pregnancy.CaseA 37‐year‐old woman at 23 weeks gestation presented with persistent dyspnea. She experienced cardiac arrest soon after arrival at the emergency room. Massive right ventricular dilatation on echocardiography during the transient return of spontaneous circulation suggested pulmonary embolism. We administered recombinant tissue plasminogen activator for suspected pulmonary embolism to successfully resuscitate the patient experiencing refractory cardiac arrest despite heparin infusion. After an additional dose of monteplase for persistent shock with remaining right ventricular dilatation on echocardiography, maternal hemodynamics dramatically improved, but fetal heart rate transiently decreased. Targeted temperature management was initiated for delayed recovery of consciousness. She fully recovered consciousness without neurological deficit. However, the fetus was aborted because of fetal hydrops.ConclusionThrombolysis and targeted temperature management should be considered as treatment options for pulmonary embolism‐induced cardiac arrest during pregnancy.

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Section: Discussionmentioning

confidence: 85%

Successful treatment of pulmonary embolism‐induced cardiac arrest by thrombolysis and targeted temperature management during pregnancy

Oami

Oshima

Oku

et al. 2018

Acute Medicine & Surgery

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“…8 Reported complications have included maternal hemorrhage, preterm delivery, fetal loss, spontaneous abortion, placenta abruption, uterine bleeding, and postpartum hemorrhage. 8,48,49 Importantly, given the prevalence of coronary dissection in pregnancy, TT may be harmful, increasing the risk of bleeding and progression of the dissection. 48,49 For these reasons, TT is rarely utilized for AMI treatment in pregnancy.…”

Section: Thrombolytic Therapymentioning

confidence: 99%

“…8,48,49 Importantly, given the prevalence of coronary dissection in pregnancy, TT may be harmful, increasing the risk of bleeding and progression of the dissection. 48,49 For these reasons, TT is rarely utilized for AMI treatment in pregnancy. Nonetheless, if PCI access for STEMI during pregnancy is not available, TT may be an alternative management strategy.…”

Section: Thrombolytic Therapymentioning

confidence: 99%

ST‐elevation acute myocardial infarction in pregnancy: 2016 update

Ismail

Wong

Rajan

et al. 2017

Clinical Cardiology

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Acute myocardial infarction (AMI) during pregnancy or the early postpartum period is rare, but can be devastating for both the mother and the fetus. There have been major advances in the diagnosis and treatment of acute coronary syndromes in the general population, but there is little consensus on the approach to diagnosis and treatment of pregnant women. This article reviews the literature relating to the pathophysiology of AMI in pregnant patients and the challenges in diagnosis and treatment of ST-elevation myocardial infarction (STEMI) in this unique population. From a cardiologist, maternal-fetal medicine specialist, and anesthesiologist's perspective, we provide recommendations for the diagnosis and management of STEMI occurring during pregnancy.

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“…However, despite limited experience with thrombolytics in pregnancy, this therapy may be lifesaving in pregnant patients with massive PE and severe hemodynamic compromise. Table reviews 23 case reports of thrombolytic use in pregnant patients with PE, excluding postpartum reports and non–English‐language reports . Patient age and gestational period ranged from 19–34 years and 8–35 weeks, respectively.…”

Section: Current Recommendationsmentioning

confidence: 99%

Thrombolysis for Massive Pulmonary Embolism in Pregnancy

et al. 2017

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Pregnant women are at high risk for venous thromboembolism, including pulmonary embolism (PE), given expected changes in coagulation, fibrinolysis, and venous blood flow. In fact, PE is the leading cause of maternal death in the United States. Nonpregnant patients who develop PE with hypotension or show signs of deterioration after anticoagulation receive thrombolytics as a standard of care. Pregnant women, however, have been excluded from clinical trials with thrombolytics, and all data available in this population are published as case reports or case series. We reviewed all reports of thrombolytics, systemic or catheter directed, used in pregnant patients with massive PE. This article summarizes the risks for thromboembolism in pregnancy, compares and contrasts thrombolytic agents in this setting, and provides a recommendation for management of massive PE in this special population. Overall, reports suggest that the use of these agents is associated with beneficial outcomes and a relatively low risk of complications. The quality of this evidence is low, and clinical judgment is required to assess individual patients for risks versus benefits of thrombolysis.

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Thrombolysis for the management of massive pulmonary embolism in pregnancy

Cited by 15 publications

References 24 publications

Successful treatment of pulmonary embolism‐induced cardiac arrest by thrombolysis and targeted temperature management during pregnancy

Successful treatment of pulmonary embolism‐induced cardiac arrest by thrombolysis and targeted temperature management during pregnancy

ST‐elevation acute myocardial infarction in pregnancy: 2016 update

Thrombolysis for Massive Pulmonary Embolism in Pregnancy

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