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BMJ Case Reports 2017; doi:10.1136/bcr-2017-221578
  • Unusual presentation of more common disease/injury
  • CASE REPORT

Systemic thrombolysis in a patient with massive pulmonary embolism and recent glioblastoma multiforme resection

Editor's Choice
  1. Matthew R Baldwin4
  1. 1 Department of Internal Medicine, Columbia University Medical Center, New York City, New York, USA
  2. 2 Division of Cardiology, Columbia University Medical Center, New York, NY
  3. 3 Division of Cardiology, Columbia University Medical Center, New York, NY
  4. 4 Division of Pulmonary and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY
  1. Correspondence to Dr Joshua Lampert, jml9026{at}nyp.org
  • Accepted 10 November 2017
  • Published 29 November 2017

Summary

While trials of systemic thrombolysis for submassive and massive pulmonary embolism (PE) report intracranial haemorrhage (ICH) rates of 2%–3%, the risk of ICH in patients with recent brain surgery or intracranial neoplasm is unknown since these patients were excluded from these trials. We report a case of massive PE treated with systemic thrombolysis in a patient with recent neurosurgery for an intracranial neoplasm. We discuss the risks and benefits of systemic thrombolysis for massive PE in the context of previous case reports, prior cohort studies and trials, and current guidelines. There may be times when the immediate risk of death from massive PE outweighs the risk of ICH from systemic thrombolysis, even when guideline-listed major contraindications exist. This case provides an example of how the haemodynamic benefit of systemic thrombolysis outweighed the impact of ICH in a patient who had undergone recent neurosurgical resection of a glioblastoma multiforme tumour.

Footnotes

  • Contributors JL, PG and MRB: manuscript, literature review, table, figures. BB: manuscript, literature review.

  • Funding National Heart, Lung, and Blood Institute (T32 HL007854).

  • Competing interests MRB is supported by NIH grants K23 AG045560 and UL1 TR001873. BB is supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, through grant number T32 HL007854.

  • Patient consent Obtained.

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

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