Successful Treatment of Acute Bilateral Pulmonary Thromboembolism Using Accelerated Regimen of Thrombolytics: A Case...

Acute pulmonary thromboembolism represents a critical, life-threatening condition that necessitates immediate and effective management to minimize associated mortality. Although the current recommendation for managing hemodynamically unstable pulmonary embolism (PE) is the regimen of 100 mg recombinant tissue plasminogen activator (rtPA) administered over two hours, an accelerated regimen of rtPA (0.6 mg/kg over 15 minutes, maximum 50 mg) has also been described for the management of PE and circulatory arrest. We report the case of a 65-year-old female patient who presented with acute bilateral pulmonary thromboembolism at intermediate-high risk. She was treated with an accelerated rtPA regimen, following which she demonstrated significant clinical improvement. Her oxygen saturation improved from 88% to 96%, and her respiratory rate decreased from 36 to 20 breaths per minute. Hemodynamic parameters remained stable throughout treatment. A computed tomography pulmonary angiogram (CTPA) performed on day 4 showed marked resolution of thrombi and improved pulmonary perfusion. No major bleeding complications occurred, and the patient was safely transitioned to oral anticoagulation. This case underscores the potential noninferiority of the accelerated thrombolysis regimen compared to the conventional two-hour regimen in terms of mortality and pulmonary vascular resistance, with a tendency toward fewer bleeding complications observed with the accelerated regimen.