Successful thrombolysis after pulmonary endarterectomy

Area of Science:

• Cardiology
• Pulmonary Hypertension
• Hematology

Background:

• Pulmonary endarterectomy is a treatment for chronic thromboembolic pulmonary hypertension.
• Heparin-induced thrombocytopenia (HIT) is a rare but serious complication of heparin therapy.
• Undiagnosed HIT can lead to severe thrombotic events.

Observation:

• A 51-year-old woman developed bilateral pulmonary thrombosis on postoperative day 1 after pulmonary endarterectomy.
• The thrombosis was attributed to previously undiagnosed heparin-induced thrombocytopenia.
• The patient presented with significant clinical deterioration.

Findings:

• Systemic thrombolytic therapy with alteplase was administered on postoperative days 5 and 6.
• The patient experienced marked clinical improvement following thrombolysis.
• This represents the first reported instance of successful thrombolysis for pulmonary thrombosis secondary to HIT after pulmonary endarterectomy.

Implications:

• This case highlights the importance of considering heparin-induced thrombocytopenia in patients presenting with thrombosis post-heparin exposure.
• Alteplase may be an effective treatment option for pulmonary thrombosis in the context of heparin-induced thrombocytopenia.
• Further research is warranted to establish optimal management strategies for HIT-related pulmonary thrombosis.