High dose streptokinase for thrombolysis in the immediate postoperative period: a case report

Venous thrombo-embolism is a life threatening condition with often non specific presentation. The detection of massive pulmonary embolism in the intra and immediate post-operative period is not only difficult due to the variety of conditions with similar presentation, but the therapy for the same is complicated with concerns of surgical and intracranial bleeding precluding various options. We present a case of massive pulmonary embolism presenting as intraoperative hypotension with an increased alveolar to arterial CO2 gradient which was subsequently managed with an accelerated regimen of streptokinase without increased postoperative bleeding. Accelerated regimen of streptokinase may be used as a safe low cost alternative modality in selected cases of massive pulmonary embolism in the immediate postoperative period.