title: Pulmonary embolism in a stroke patient after systemic thrombolysis: clinical decisions and literature review.
abstract: Pulmonary embolism can be a catastrophic event that can result in early death or serious hemodynamic dysfunction. The dehydration, immobility, and infections occurring in acute stroke patients puts these patients at risk of developing deep vein thrombosis and pulmonary embolism. Recombinant tissue-type plasminogen activator (rt-PA) is the established therapy for acute ischemic stroke, and its prompt administration results in a better outcome in stroke patients. We describe a 73-year-old man who arrived at the emergency room within 2 hours of acute onset of left hemiparesis who was treated with rt-PA and suffered a pulmonary embolism 3 days after acute stroke therapy. rt-PA is also a current therapy for pulmonary embolism, but an ischemic stroke in the previous 3 months is an absolute contraindication to thrombolysis because of the high risk of intracranial hemorrhage. We discuss clinical and therapeutic decisions and review the current literature.
authors.affiliation: Stroke Unit, Institute of Neurology, Università Cattolica, Rome, Italy. Electronic address: fabio.pilato@rm.unicatt.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pilato
authors.forename: Rosalinda
authors.initials: R
authors.lastname: Calandrelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Profice
authors.forename: Giacomo
authors.initials: G
authors.lastname: Della Marca
authors.forename: Aldobrando
authors.initials: A
authors.lastname: Broccolini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bello
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bocci
authors.forename: Marisa
authors.initials: M
authors.lastname: Distefano
authors.forename: Cesare
authors.initials: C
authors.lastname: Colosimo
authors.forename: Paolo Maria
authors.initials: PM
authors.lastname: Rossini
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute stroke; deep venous thrombosis; heparin; pulmonary embolism; rt-PA; systemic thrombolysis