A successful thrombolysis with tissue-type plasminogen activator in a case of pulmonary embolism after failed streptokinase therapy

Alt ekstremite derin ven trombozuna bagli olusan akut, masif pulmoner emboli tanisi konmus 76 yasinda erkek hastada ciddi kardiyovaskuler ve solunumsal instabilite gelisti. Takiben hastaya iki saat sureyle streptokinaz infuzyonu verildi. Trombolitik tedavi sonrasi hemodinamik kararsizligin devam etmesi uzerine, spiral bilgisayarli tomografi cekildi. Bilgisayarli tomografi, masif pulmoner embolinin sebat ettigini gosterdi. Literatur verileri isiginda hastaya cerrahi pulmoner embolektomi onerildi; ancak hasta cerrahiyi reddetti. Bunun uzerine hastaya iki saat sureyle intravenoz rekombinant doku tipi plazminojen aktivatoru verildi. Tedavi sonrasinda hastanin klinik durumu ve radyolojik bulgulari belirgin olarak duzeldi. Hasta efektif antikoagulan tedavi ile taburcu edildi. Anah tar soz cuk ler: Bilgisayar tomografi; pulmoner emboli; trombolitik tedavi. A 76-year-old male patient diagnosed with acute, massive pulmonary embolism due to deep vein thrombosis of a lower extremity developed significant cardiovascular and respiratory instability. Subsequently, streptokinase infusion was administered over two hours. Spiral computed tomography was performed due to the persistent hemodynamic instability following the thrombolytic therapy. Computed tomography showed persistent massive pulmonary embolism. In the light of literature data, the patient was recommended for surgical pulmonary embolectomy, however he refused surgery. Therefore, he was administered intravenous recombinant tissue type plasminogen activator over two hours. Clinic status of the patient and radiological findings were significantly improved following therapy. The patient was discharged with effective anticoagulant therapy.