Abstract
Intravenous thrombolysis is the preferred treatment for massive pulmonary embolism
with hemodynamic instability, when there are no contraindications to the therapy.
However, when absolute contraindications to thrombolysis are present, clinicians are
at a crux, especially when mechanical thrombectomy is also not possible. We present
a case of a 40-year-old man with polytrauma with head injury who developed massive
pulmonary embolism requiring intravenous thrombolysis on day 15 after decompressive
craniotomy—possibly a first in the literature. The patient, however, successfully
recovered from this near-fatal episode. With this report, we wish to highlight that
at a near-dying situation, no contraindication is absolute, and all possible efforts
must be made by the clinician to save the patient.
Keywords
massive pulmonary embolism - alteplase - traumatic head injury - thrombolysis
