Recurrent high-risk pulmonary thromboembolism treated with repeated thrombolytic therapy could be helpful for certain patients: a case report and review of the literature
  • Leila Bigdelu
    Division of Cardiovascular Medicine, Vascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
  • Negar Ebrahimi
    Student Research Committee, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
  • Ossama Maadarani
    Critical Care Unit, Internal Medical Department, Ahmadi Hospital-Kuwait Oil Company, Kuwait


High-risk pulmonary thromboembolism, alteplase, systemic thrombolysis


Acute pulmonary thromboembolism (PTE) is considered the third most frequent acute cardiovascular syndrome behind myocardial infarction and stroke, with annual incidence rates ranging from 39 to 115 per 100,000 people and ranking high among the causes of cardiovascular mortality. High-risk PTE is characterised by haemodynamic instability and encompasses clinical manifestations such as cardiac arrest, obstructive shock and persistent hypotension. The European Society of Cardiology (ESC) recommends a reperfusion strategy with systemic thrombolytic therapy for high-risk PTE under class I, level B if there are no contraindications. Overall, unsuccessful thrombolytic therapy and recurrent PTE have been reported in 8% of patients with high-risk PTE. The guidelines recommend surgical pulmonary embolectomy if thrombolysis is contraindicated or has failed. The position of repeated thrombolytic therapy as a treatment option in patients with recurrent high-risk PTE, especially in situations with a lack of surgical expertise or resources, was not mentioned in the guidelines. We report the case of a patient who suffered a recurrent high-risk PTE and was treated with repeated thrombolytic therapy that was effective and resulted in excellent outcomes.



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    Published: 2023-08-25
    Issue: 2023: Vol 10 No 9 (view)

    How to cite:
    Bigdelu L, Ebrahimi N, Maadarani O. Recurrent high-risk pulmonary thromboembolism treated with repeated thrombolytic therapy could be helpful for certain patients: a case report and review of the literature. EJCRIM 2023;10 doi:10.12890/2023_004042.