Thrombolysis of late acute pulmonary embolism post-COVID-19
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2022.189641Keywords:
COVID-19, SARS-CoV-2, Pulmonary embolism, Thrombolysis, AlteplaseAbstract
Late pulmonary embolism (PE) in COVID-19 occurs weeks after SARS-CoV-2 infection and has been reported even in patients presenting mild influenza syndrome. There is no reliable explanation for its occurrence, but it appears to involve the persistence of viral inflammatory changes associated with phospholipid exposure and the release of potentially thrombogenic membrane microparticles. Thrombolysis with plasminogen activators, especially alteplase, is well established in high-risk PE cases and considered in intermediate-high risk events. These drugs promote benefits such as pulmonary reperfusion, pulmonary artery pressure reduction, and right ventricular (RV) stabilization. However, there are few reported cases of thrombolysis in PE secondary to COVID-19. We present the case of an adult female patient without significant risk factors for thrombogenic events diagnosed with mild COVID-19 who, on day 18, after symptom onset, evolved with PE associated with RV instability and underwent thrombolysis with intravenous alteplase successfully.
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Copyright (c) 2022 André Luiz Cicilini, Lucas Kajihara, Michele Higa Fróes, Jamilton de Medeiros Eduardo
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