Agnes Kristine Orteza
Makati Medical Center, PhilippinesTitle: Usage of streptokinase in reducing thrombus burden in patients with high risk pulmonary embolism before mechanical thrombectomy
Abstract
Background: Venous Thromboembolism is a worldwide crisis. Deep vein thrombosis (DVT) and pulmonary embolism (PE) are indeed interconnected conditions within the spectrum of Venous Thromboembolism (VTE). The severity of PE is influenced by several factors, including the embolus size, its location within the pulmonary arteries, and the overall cardiopulmonary health of the individual. The acute increase in pulmonary artery pressure due to the obstruction of blood flow by the embolus can lead to increased strain on the right ventricle. This increased right ventricular afterload can result in dysfunction, leading to potentially life-threatening complications. PE therefore poses a serious mortality threat which warrants a timely treatment course.
Methods: This is a case of a 40 year old, female, diabetic, obese and smoker who presented with sudden onset dyspnea, chest discomfort and syncope. She was eventually diagnosed and managed as a case of High Risk Pulmonary embolism with documentation of an emboli on both right and left main pulmonary arteries on CTPA. Patient was initially treated with Streptokinase infusion continued over 24 hours due to initial refusal for thrombectomy. Over the course of the admission, patient deteriorated with increasing oxygen requirement and inotrope support and ultimately underwent thrombectomy with catheter directed thrombolysis with Alteplase and was given Low molecular weight heparin and DOACs thereafter.
Results: Thrombectomy findings revealed no filling defects in the left pulmonary artery in contrast to CTPA findings which would support the assumption that Streptokinase reduced the thrombus burden in the said patient. Patient was eventually discharged well with a satisfactory 6 minute walk test.
Conclusions: Thrombolysis is widely accepted as the treatment of choice for acute massive life-threatening pulmonary embolism. Although newer thrombolytics such as Alteplase are more commonly used in clinical practice, Streptokinase is still a non inferior treatment regimen in the management of pulmonary embolism.
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