ICU SAQs · Haematology / coagulation
Massive PE with shock — thrombolysis or embolectomy?
A CICM SAQ on high-risk PE: alteplase 100 mg over 2 h (Konstantinides), PEITHO bleeding cost of routine lysis in intermediate-risk PE, UFH around instability, and PREPIC2 — filters do not add PE prevention once anticoagulation can be given.
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Prompt
A 60-year-old post-surgery develops the sudden dyspnoea, the hypotension (SBP 80), the RV strain on the echo, and the CT-confirmed PE. Discuss the management.
Question
A 60-year-old post-surgery develops the sudden dyspnoea, the hypotension (SBP 80), the RV strain on the echo, and the CT-confirmed PE. Discuss the management.[1]
References4ShowHide
- [1]Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism N Engl J Med, 2002.PMID 12374874
- [2]Meyer G, Vicaut E, Danays T, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism N Engl J Med, 2014.PMID 24716681
- [3]Mismetti P, Laporte S, Pellerin O, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial JAMA, 2015.PMID 25919526
- [4]Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report Chest, 2016.PMID 26867832