BMJ Case Reports 2017; doi:10.1136/bcr-2017-219837
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Use of low-dose thrombolytics for treatment of intracardiac thrombus and massive pulmonary embolus after aborted liver transplant leads to recovery of right ventricular function and redo liver transplantation

  1. Irene Kim3
  1. 1Pulmonary and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
  2. 2Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
  3. 3Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr Aarya Kafi, aarya.kafi{at}
  • Accepted 12 June 2017
  • Published 6 July 2017


This is a 61-year-old man with end-stage liver disease who experienced cardiac arrest secondary to a massive pulmonary embolus and intracardiac thrombus during cannulation for veno-venous extracorporeal membrane oxygenation (ECMO) in preparation for orthotopic liver transplantation (OLT). Surgery was aborted and the patient was taken back to the intensive care unit in cardiogenic shock on multiple vasopressors. The patient was unresponsive to heparin bolus and too high risk for systemic thrombolytics or embolectomy. He was ultimately treated with 12 mg total of alteplase through his pulmonary artery catheter over 3 hours. He had subsequent resolution of his cardiogenic shock and proceeded with successful liver transplantation 5 days after his initial event without any bleeding complications. Low-dose thrombolytic therapy in the setting of absolute contraindications to thrombolysis allowed for recovery of cardiac function and, ultimately redo OLT in a patient with otherwise little hope of survival.


  • Contributors All listed authors contributed substantially to the conception, drafting and revising of this case report. The final version of this manuscript was subject to the approval of all listed authors. All authors agree to be accountable for all aspects of the work submitted. The literature search was performed by AK and he will serve as the guarantor. The case was managed in the ICU by IK and OF.

  • Competing interests None declared.

  • Patient consent Next of kin obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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