Thrombolytic therapy for massive pulmonary embolism in a patient with a known intracranial tumor.
The objective was to describe and review the use of thrombolytic therapy in a patient with an intracranial tumor and massive pulmonary embolism. This is the first reported case of a patient with a known glioblastoma multiforme and massive pulmonary embolism who was successfully treated with alteplase. Pulmonary embolism was demonstrated by a ventilation-perfusion scan and transthoracic echocardiogram with repeat studies demonstrating resolution of the thromboembolism and reperfusion of pulmonary vasculature. A review of the literature revealed that the incidence of intracranial hemorrhage with thrombolysis is <3% and compares favorably with the much higher mortality rate of 25% to >/=50% in patients with hemodynamically unstable pulmonary emboli. The benefit of thrombolysis may outweigh the risks of intracranial hemorrhage in these patients, and careful consideration for its use in these patients is warranted.
Han
Steve
S
VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Geffen School of Medicine at UCLA, Los Angeles, California 90073, USA.
Chaya
Craig
C
Hoo
Guy W Soo
GW
D000368:Aged; D001932:Brain Neoplasms / Q000150:complications*; D000075202:Contraindications; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005909:Glioblastoma / Q000150:complications*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator