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Thrombolysis in a pregnant patient with massive Pulmonary embolism

Three Part Question

[In a pregnant patient with pulmonary embolism][does giving thrombolysis][help reduce the mortality]

Clinical Scenario

a 24 weeks pregnant women comes to the A&E dept with sudden haemodynamic collapse(hypotensive/tachycardic & hypoxic), She has no previous medical history and the pregnancy has been uneventful so far. You find a rt sided swollen,erythematous and tender rt lower limb suggestive of DVT. You wonder whether thrombolysis will help this lady improve her clinical outcome from PE

Search Strategy

OVID Medline 1950 to April 2007
Cochrane search
Embase search
exp pregnancy complications,hematologic/ or exp pregnancy complications/ or or exp pregnancy/ or exp pregnancy complications cardiovascular/pregnan$.mp./gravid$.mp.exp pulmonary embolism/exp pulmonary embolism/pulmonary embol$.mp./thromboembol$.mp./ fibrinolytic agents/ or exp thrombolytic therapy/ or tissue plasminogenactivator/ or exp anistreplase/(thromboly$ or fibrinoly$ or reteplase or streptokinase or tenecteplase or alteplase).mp/exp fibrinolytic therapy/exp thrombolytic therapy/

Search Outcome

254 papers were found but only 9 were relevant.
All the papers were either case reports or review articles

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
P K Mazeika
34 years old,24 weeks pregnant patient with PE, first pregnancy,case reportsafe thrombolysismother and child safelevel 5 evidence
M de Sweit
pregnant patients with pulmonary embolismreview articlethrombolysis recommended in pregnant PE patients with haemodynamic instabilityevidence based on case series
G S Ahearn
24 yrs old pregnant patient with haemodynamic unstability,12 weeks durationcase report and review articlemother and child savedgrade 5 evidence
A T Marty
post cesarean section pulmonary embolism treated with surgical embolectomycase reportpatient survivedlevel 5 evidence
I A Greer
Glasgow UK
pregnant patients with thromboembolismreview articlePE patients with haemodynamic upset were'nt reviewed
M Gujrar
25 yrs old ,one post ceaserian section, haemodynamically unstable thromboembolism, treated with thrombolysiscase reportpatient survived
G Leonheart
thrombolysis in pregnant patient with ischaemic strokereview article and case reportpatient survived and recovered


Thrombolytic therapy for pulmonary embolism in pregnancy has been found to be safe for both maternal and foetal cases but the evidence is based on case reports only.

Clinical Bottom Line

Thrombolytic therapy for pulmonary embolism during pregnancy can be only considered for cases with haemodynamic instability and expert advice has to be considered at present on case by case basis till further research is carried out.


  1. P Mazeika European Heart Journal
  2. M de Swiet European heart Journal
  3. L B Yap international journal of cardiology
  4. G S Ahearn Archives of internal medicine
  5. A T Marty American college of O & G
  6. Prof I A Greer Gender Medicine
  7. M Gujrar indian journal of medicine
  8. G Leonheart J Throm Thrombolysis