The Difficult Clinical Decision of Thrombolytic Therapy for Submassive Pulmonary Embolism in a Community Hospital

Submassive or intermediate-risk pulmonary embolism (PE) occurs when an acute PE episode is associated with radiographic evidence of right heart strain without hemodynamic instability. Further risk stratification is important in determining whether systemic thrombolytic therapy should be administered when weighing the risks and benefits. It includes the risk of death from acute PE versus the risk of bleeding. This decision could be further complicated in institutions where there is a lack of complete therapeutic options, which increases the importance of the expertise of a pulmonologist or an intensivist to decide whether rescue reperfusion is needed. We describe the case of a 34-year-old female patient with a history of right thigh abscess and diabetes mellitus who was admitted for diabetic ketoacidosis (DKA) along right thigh abscess status post-incision and drainage. She had a syncopal episode and was found to have submassive PE with right heart strain with stable hemodynamics and oxygen requirement. She tolerated systemic thrombolytic therapy without complications with a drastic improvement in her cardiac function post-treatment.