Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism in the Third Trimester of Pregnancy

Compadre, Amanda; Kohi, Maureen; Lokken, R. Peter; Blissett, Sarah; Harris, I.; Lucero, Jennifer; Rosenstein, Melissa G.; Sobhani, Nasim C.

doi:10.1016/j.jaccas.2020.08.022

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…There are growing numbers of case reports in the literature of catheter-directed therapies, using equipment dedicated to PE intervention in PAPE, with good short-term results. 7 , 8 The formulation of an individualized treatment plan for each PE patient and use of catheter-directed therapies should ideally directed by a multi-disciplinary PERT, as shown here. 5 This case highlights the novel application of large bore catheter-directed suction thrombectomy to PAPE, as a promising and useful technique to manage these difficult cases, allowing for quick normalization of pulmonary pressures, avoidance of haemodynamic deterioration, without the need for thrombolytics, major surgery, significant blood loss or prolonged hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Large-bore suction thrombectomy for sub-massive pulmonary embolism during second trimester of pregnancy: a case report

Kojodjojo,

Ng,

Ong

et al. 2023

European Heart Journal - Case Reports

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Background Pregnancy associated pulmonary embolism (PAPE) remains a significant cause of maternal mortality. Anticoagulation remains the mainstay of therapy for most PE-related pregnancies. However, in patients with haemodynamic compromise or those refractory to anticoagulation, management is challenging. Systemic thrombolysis is associated with a substantial risk of maternal bleeding and fetal loss. In non-pregnant PE patients, large bore catheter directed suction thrombectomy is a proven and important technique to manage intermediate or high-risk PE, allowing for normalization of pulmonary pressures, avoidance of haemodynamic deterioration, without the need for thrombolytics, major surgery, significant blood loss or prolonged hospitalization. Case Summary A primigravid patient in her second trimester of pregnancy, initially diagnosed with a deep vein thrombosis refractory to heparin, presents with near-syncope due to sub-massive pulmonary embolism. The various management options including thrombolysis and surgical embolectomy etc. were discussed in detail by a multi-disciplinary PE team. She underwent large bore suction thrombectomy with complete thrombi removal, normalization of right heart strain, without the need for thrombolytics or surgery, minimal blood loss and was discharged after a short length of stay. She gave birth at term to a healthy infant. Conclusion Suction thrombectomy is an important consideration for physicians managing high risk PAPE and is likely to be associated with much lower risk of maternal and fetal mortality compared to thrombolysis or surgery.

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Section: Discussionmentioning

confidence: 99%

Large-bore suction thrombectomy for sub-massive pulmonary embolism during second trimester of pregnancy: a case report

Kojodjojo,

Ng,

Ong

et al. 2023

European Heart Journal - Case Reports

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“…In order to close this gap, CDT is currently being evaluated in a phase III clinical trial (NCT04790370). However, pregnancy constitutes an exclusion criterion of the trial and only few cases of pregnant women treated with CDT have been published in literature yet ( 27 , 45 , 46 ). Surgical embolectomy or percutaneous thrombectomy are reasonable treatment options, when needed in the immediate postpartum period, to avoid the bleeding risks of thrombolysis.…”

Section: Treatment Of Acute Pulmonary Embolism In Pregnant Women—high...mentioning

confidence: 99%

Pulmonary Embolism and Pregnancy—Challenges in Diagnostic and Therapeutic Decisions in High-Risk Patients

Hobohm

Farmakis

Münzel

et al. 2022

Front. Cardiovasc. Med.

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Diagnosis of acute PE in pregnant women with haemodynamic instability is following the general integrated risk-adapted diagnostic algorithm and starts with bedside echocardiography to assess RV function. If RV dysfunction is identified, a prompt and immediate reperfusion without further imaging should be initiated. Although pregnancy is listed as a relative contraindication of systemic thrombolysis, in pregnant women with acute PE and haemodynamic instability thrombolysis must be considered. In those cases, other treatment strategies as surgical embolectomy or catheter-directed low-dose thromboylysis or percutaneous thrombectomy should be taken into consideration as well. A multidisciplinary team with experience of PE management in pregnancy should be consulted to reach consensus on the best treatment approach.

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Obstetric Disorders and Critical Illness

Griffin

Oxford-Horrey

Bourjeily

2022

Clinics in Chest Medicine

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Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism in the Third Trimester of Pregnancy

Cited by 4 publications

References 14 publications

Large-bore suction thrombectomy for sub-massive pulmonary embolism during second trimester of pregnancy: a case report

Large-bore suction thrombectomy for sub-massive pulmonary embolism during second trimester of pregnancy: a case report

Pulmonary Embolism and Pregnancy—Challenges in Diagnostic and Therapeutic Decisions in High-Risk Patients

Obstetric Disorders and Critical Illness

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