SHM Converge Scientific Abstract ePoster Gallery-The Clot Thickens: The Dilemma of Thrombolytic Therapy in Post-Surgical Stroke and Pulmonary Embolism

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The document describes a severe thromboembolic and neurologic hospital course. The patient had an extensive right lower extremity deep vein thrombosis and was started on a heparin drip. On day 4, he suffered cardiopulmonary collapse with pulseless electrical activity arrest. He was emergently intubated, given half-dose tPA, and achieved return of spontaneous circulation after 6 CPR cycles. Because of a high clot burden with right ventricular strain, bilateral mechanical thrombectomy and IVC filter placement were performed.<br /><br />Subsequently, brain imaging showed a large right middle cerebral artery territory ischemic stroke involving the right temporal, frontal, and parietal lobes with associated edema. To evaluate for a paradoxical embolic source, transesophageal echocardiography identified a patent foramen ovale, which was then closed percutaneously.<br /><br />On day 7, significant swelling and bruising developed over the lumbar wound. MRI revealed a large epidural hematoma from T12 to L5 causing spinal canal stenosis. The heparin infusion was stopped, and the patient underwent emergent surgical evacuation of the hematoma.<br /><br />Because of prolonged respiratory failure and need for extended ventilatory support, a tracheostomy was performed. Before discharge, the patient was transitioned to apixaban and transferred to a long-term acute care facility for rehabilitation.

Asset Subtitle

Vamsi S. Sanagala

Meta Tag

Author List Aayushi Kacheria, Neha Panchagnula, Vamsi S. Sanagala

Category Clinical Vignettes

Concept Deep Vein Thrombosis

Concept Cardiopulmonary Collapse

Concept Pulseless Electrical Activity

Concept Spinal Hematoma

Concept Thromboembolism

Distinguished Non-Finalist

Presenter Organization Abrazo Health Network Internal Medicine Residency Program

Presenting Author Vamsi S. Sanagala

Track Adult

Keywords

deep vein thrombosis

pulmonary embolism

cardiopulmonary arrest

tPA thrombolysis

mechanical thrombectomy

inferior vena cava filter

ischemic stroke

patent foramen ovale

epidural hematoma

tracheostomy

Deep Vein Thrombosis

Cardiopulmonary Collapse

Pulseless Electrical Activity

Spinal Hematoma

Thromboembolism