Thrombolytic therapy is regarded as the first treatment choice in haemodynamically unstable patients with pulmonary embolism. Intracranial tumors have long been considered as a contraindication to thrombolytic therapy due to the risk of intracerebral haemorrhage. In this report, we presented a 76-year-old female patient with meningioma and massive pulmonary embolism who had received thrombolytic therapy despite a contraindication of intracranial mass. The patient completed the thrombolytic therapy without having complication. (Hong Kong j.emerg.med. 2014;21:98-102)
BullerH.R., AgnelliG., HullR.D., HyersT.M., PrinsM.H., RaskobG.E.Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest2004; 126(3 Suppl): 401S–28S.
2.
QaseemA., SnowV., BarryP., HornbakeE.R., RodnickJ.E., TobolicT.Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Fam Med2007; 5(1): 57–62.
3.
WellsP.S., AndersonD.R., RodgerM., StiellI., DreyerJ.F., BarnesD.Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med2001; 135(2): 98–107.
4.
KlokF.A., MosI.C., NijkeuterM., RighiniM., PerrierA., Le GalG.Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med2008; 168(19): 2131–6.
5.
DoumaR.A., MosI.C., ErkensP.M., NizetT.A., DurianM.F., HovensM.M.Performance of 4 Clinical Decision Rules in the Diagnostic Management of Acute Pulmonary Embolism: A Prospective Cohort Study. Ann Intern Med2011; 154(11): 709–18.
6.
GoldhaberS.Z., ElliottC.G.Acute pulmonary embolism: part I: epidemiology, pathophysiology, and diagnosis. Circulation2003; 108(22): 2726–9.
7.
KonstantinidesS.Pulmonary embolism: impact of right ventricular dysfunction. Curr Opin Cardiol2005; 20(6): 496–501.
8.
TorbickiA., PerrierA., KonstantinidesS., AgnelliG., GalièN., PruszczykP.Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J2008; 29(18): 2276–315.
9.
HirshJ., GuyattG., AlbersG.W., HarringtonR., SchünemannH.J.Executive summary: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest2008; 133(6 Suppl): 71S–109S.
NijkeuterM., HovensM.M., DavidsonB.L., HuismanM.V.Resolution of thromboembolism in patients with acute pulmonary embolism: a systematic review. Chest2006; 129: 192–7.
12.
LaporteS., MismettiP., DecoususH., UresandiF., OteroR., LoboJ.L.Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation2008; 117(13): 1711–6.
13.
LeeA.Y., LevineM.N., BakerR.I., BowdenC., KakkarA.K., PrinsM.Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med2003; 349(2): 146–53.
14.
GoldhaberS.Z., VisaniL., De RosaM.Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet1999; 353(9162): 1386–9.
15.
KasperW., KonstantinidesS., GeibelA., OlschewskiM., HeinrichF., GrosserK.D.Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol1997; 30(5): 1165–71.
16.
KucherN., RossiE., De RosaM., GoldhaberS.Z.Massive pulmonary embolism. Circulation2006; 113(4): 577–82.
17.
RoseP.S., PunjabiN.M., PearseD.B.Treatment of right heart thromboemboli. Chest2002; 121(3): 806–14.
18.
GoldhabertS.Z., KesslerC.M., HeitJ.A., ElliottC.G., FriedenbergW.R., HeiselmanD.E.Recombinant tissue-type plasminogen activator versus a novel dosing regimen of urokinase in acute pulmonary embolism: a randomized controlled multicenter trial. J Am Coll Cardiol1992; 20(1): 24–30.
19.
KanterD.S., MikkolaK.M., PatelS.R., ParkerJ.A., GoldhaberS.Z.Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest1997; 111(5): 1241–5.
20.
JaffeR., ReichmanJ.M., WeissA.T., ZahgerD.Thrombolysis in the presence of an intracranial meningioma. Chest1997; 111(1): 258.
21.
RubinshteinR., JaffeR., FlugelmanM.Y., KarkabiB., LewisB.S.Thrombolysis in patients with a brain tumour. Heart2004; 90(12): 1476.
22.
NeilW., OvbiageleB.Intravenous thrombolysis in ischemic stroke patients with intracranial neoplasms: two cases and a literature review. Case Rep Med2011; 2011: 503758.
23.
GrimmS.A., DeAngelisL.M.Intratumoral hemorrhage after thrombolysis in a patient with glioblastoma multiforme. Neurology2007; 28; 69(9): 936.
