SUCCESSFUL DELAYED THROMBOLYTIC THERAPY IN A PATIENT WITH A MASSIVE PULMONARY-EMBOLISM

Pulmonary embolism can be catastrophic event leading to early death or serious hemodynamic instability. thrombolytic therapy, in addition to heparin therapy, may improve the clinical condition and reduce the ch ance of recurrent pulmonary embolism in some cases. However, the accep table ''time window'' for thrombolytic therapy is not well documented, though it has been used successfully as late as 14 days after pulmona ry embolism. Successful delayed thrombolytic therapy beyond this ''tim e window'' in patients with massive pulmonary embolism has not been re ported. We report a case of massive pulmonary embolism in which thromb olytic therapy was delayed more than 1 month after symptom onset. A 56 -year-old woman was taken to National Cheng Kung University Hospital b ecause of an episode of recurrent syncope, followed by progressive sho rtness of breath of 1 month's duration. Hypoxemia and hemodynamic inst ability were noted on admission. Echocardiography and a lung perfusion scan provided strong evidence of pulmonary embolism. Subsequent pulmo nary angiography confirmed the diagnosis of multiple pulmonary emboli. The patient received a standard dose of intravenous tissue plasminoge n activator 7 days after admission because of persistent symptoms and hypoxemia. her clinical condition dramatically improved after treatmen t. Follow-up imaging studies showed resolution of the emboli. She was discharged in good condition. This case suggests that delayed thrombol ytic therapy in patients with massive pulmonary embolism can still be beneficial in selected cases, even if given more than 2 weeks after sy mptom onset.