Double bad luck: pulmonary embolism and vaginal bleeding - a case report

Area of Science:

• Cardiology
• Gynecology
• Pharmacology

Background:

• Pulmonary embolism (PE) is a significant cause of mortality.
• Combined oral contraceptives (COCs) containing exogenous estrogens elevate venous thromboembolism (VTE) risk.
• Discontinuing COCs in anticoagulated patients may precipitate severe withdrawal bleeding.

Purpose of the Study:

• To present a case of submassive pulmonary embolism treated with thrombolysis and anticoagulation.
• To highlight the complication of severe vaginal bleeding after COC discontinuation in an anticoagulated patient.
• To emphasize the importance of menstrual history in anticoagulation management for women.

Main Methods:

• Case report of a 47-year-old female with dyspnea and chest pain.
• Diagnostic workup included transthoracic echocardiogram and CT scan.
• Treatment involved thrombolysis with alteplase and anticoagulation with rivaroxaban.

Main Results:

• Bilateral pulmonary embolism with pulmonary hypertension and right ventricular dilatation confirmed.
• Patient experienced severe vaginal bleeding five days after hospital discharge following COC cessation.
• This adverse event occurred despite appropriate anticoagulation for PE.

Conclusions:

• Discontinuation of COCs, while crucial for reducing VTE recurrence, requires careful timing.
• Postponing COC cessation until completion of anticoagulation and establishing alternative contraception is recommended.
• Thorough menstrual history is vital for managing anticoagulation in women using hormonal contraceptives.