Life-threatening recurrent pulmonary embolism following anticoagulation withdrawal: a case report emphasising the management dilemma in resource- constrained settings
Dublin Core
Title
Life-threatening recurrent pulmonary embolism following anticoagulation withdrawal: a case report emphasising the management dilemma in resource- constrained settings
Subject
Case report, Pulmonary embolism, Deep vein thrombosis, Unprovoked venous thromboembolism,
Systemic thrombolysis
Systemic thrombolysis
Description
Abstract
Introduction Pulmonary embolism (PE) is a life-threatening condition often presenting diagnostic and therapeutic
challenges. Its clinical presentation can mimic cardiac conditions, complicating timely diagnosis. Managing PE,
particularly in cases of unprovoked venous thromboembolism (VTE), requires balancing the prevention of recurrence
with the risk of bleeding.
Case presentation A 50-year-old woman presented with chest pain and dyspnoea suggestive of acute coronary
syndrome. Echocardiography revealed significant right heart strain and a pulmonary artery thrombus. Systemic
thrombolysis with alteplase initially improved her condition but led to severe bleeding, necessitating anticoagulation
cessation. This interruption resulted in VTE recurrence, with a large thrombus in the right atrium, ultimately proving
fatal.
Conclusion This case highlights the diagnostic challenges of PE and the limitations of clinical scoring systems.
Imaging played a critical role in confirming the diagnosis. The therapeutic dilemma of balancing anticoagulation to
prevent recurrence while minimising bleeding risks underscores the need for tailored management strategies, such
as reduced-dose direct oral anticoagulants or catheter-directed thrombolysis. Individualised, dynamic management
is essential in complex PE cases. Integrating advanced imaging, risk stratification, and multidisciplinary care can help
optimise outcomes while addressing the dual risks of thrombosis and haemorrhage.
Keywords Case report, Pulmonary embolism, Deep vein thrombosis, Unprovoked venous thromboembolism,
Systemic thrombolysis
Introduction Pulmonary embolism (PE) is a life-threatening condition often presenting diagnostic and therapeutic
challenges. Its clinical presentation can mimic cardiac conditions, complicating timely diagnosis. Managing PE,
particularly in cases of unprovoked venous thromboembolism (VTE), requires balancing the prevention of recurrence
with the risk of bleeding.
Case presentation A 50-year-old woman presented with chest pain and dyspnoea suggestive of acute coronary
syndrome. Echocardiography revealed significant right heart strain and a pulmonary artery thrombus. Systemic
thrombolysis with alteplase initially improved her condition but led to severe bleeding, necessitating anticoagulation
cessation. This interruption resulted in VTE recurrence, with a large thrombus in the right atrium, ultimately proving
fatal.
Conclusion This case highlights the diagnostic challenges of PE and the limitations of clinical scoring systems.
Imaging played a critical role in confirming the diagnosis. The therapeutic dilemma of balancing anticoagulation to
prevent recurrence while minimising bleeding risks underscores the need for tailored management strategies, such
as reduced-dose direct oral anticoagulants or catheter-directed thrombolysis. Individualised, dynamic management
is essential in complex PE cases. Integrating advanced imaging, risk stratification, and multidisciplinary care can help
optimise outcomes while addressing the dual risks of thrombosis and haemorrhage.
Keywords Case report, Pulmonary embolism, Deep vein thrombosis, Unprovoked venous thromboembolism,
Systemic thrombolysis
Creator
Pradana Pratomo Raharjo1* , Alice Valeria Wiyono1* , Ulrike Panjaitan1 , Iwan Cahyo Santosa Putra1 ,
Katherine Hermanto1 , Triwedya Indra Dewi1 and Miftah Pramudyo1
Katherine Hermanto1 , Triwedya Indra Dewi1 and Miftah Pramudyo1
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Pradana Pratomo Raharjo1* , Alice Valeria Wiyono1* , Ulrike Panjaitan1 , Iwan Cahyo Santosa Putra1 ,
Katherine Hermanto1 , Triwedya Indra Dewi1 and Miftah Pramudyo1, “Life-threatening recurrent pulmonary embolism following anticoagulation withdrawal: a case report emphasising the management dilemma in resource- constrained settings,” Repository Horizon University Indonesia, accessed April 18, 2026, https://repository.horizon.ac.id/items/show/13238.