Massive pulmonary embolism in pregnancy treated with streptokinase and percutaneous catheter fragmentation

Abstract

Despite heightened awareness, pulmonary embolism remains a major cause of maternal mortality in the antenatal period and one which has not decreased in incidence over the four triennia since 1976. We report a patient who suffered massive pulmonary embolism with circulatory collapse in the second trimester and who was treated with intravenous streptokinase followed by percutaneous mechanical dispersion of thrombus using a catheter and guide wire. She made an excellent recovery despite complicating antepartum haemorrhage. In life-threatening circumstances pharmacological thrombolysis is mandatory particularly for hospitals without a cardiac catheterization laboratory on site.

A new thrombectomy catheter device (AngioJet) for the disruption of thrombi: An in vitro study

“…In addition, bleeding complications and delayed or failed recanalization reduce its safety and effectiveness. For this reason several mechanical thrombectomy devices have been tested as a primary or additional therapy in acute massive pulmonary embolism [11][12][13][14][15][16][17][18][19][20][21], acute myocardial infarction [22][23][24][25][26][27][28][29][30][31][32][33], and in acute and subacute peripheral artery thromboembolism and occlusion [34][35][36].…”

Massive Pulmonary Embolism: Treatment with Thrombus Fragmentation and Local Fibrinolysis with Recombinant Human-Tissue Plasminogen Activator

“…Successful clot fragmentation and thrombolysis has even been described during pregnancy and intraoperatively during venous thrombectomy [7,10]. In one other patient described, this therapy failed, probably because of older emboli adherent to the vessel wall.…”

“…The intervention can be performed immediately after diagnostic angiography. The effectiveness of combined clot fragmentation and local fibrinolysis has been demonstrated with the use of streptokinase and urokinase as fibrinolytic drugs [1,[5][6][7]. One study with the use of intravenous rtPA showed some advantages, with a more rapid and safer action compared with urokinase [8].…”

Massive pulmonary embolism in late pregnancy

“…A combination of streptokinase and percutaneous catheter fragmentation has also been used successfully in pregnancy at 25 wk gestation. 9 A case report in 1985 discussed a woman presenting at 35 wk gestation with a massive PE, in active labour. Is Despite cardiorespiratory compromise, labour was allowed to proceed and resulted, eight hours later, in the spontaneous vaginal delivery of a 2.3 kg live infant.…”