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Journal of Intensive Care Medicine
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Thrombolytic Therapy for Massive Pulmonary Embolism in a Patient With a Known Intracranial Tumor

Steve Han, MD

VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Geffen School of Medicine at UCLA, Los Angeles, California

Craig Chaya, MD

VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Geffen School of Medicine at UCLA, Los Angeles, California

Guy W. Soo Hoo, MD

VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Geffen School of Medicine at UCLA, Los Angeles, California, Guy.Soohoo{at}med.va.gov

The objective was to describe and review the use of thrombolytic therapy in a patient with an intracranial tumor and massive pulmonary embolism. This is the first reported case of a patient with a known glioblastoma multiforme and massive pulmonary embolism who was successfully treated with alteplase. Pulmonary embolism was demonstrated by a ventilation-perfusion scan and transthoracic echocardiogram with repeat studies demonstrating resolution of the thromboembolism and reperfusion of pulmonary vasculature. A review of the literature revealed that the incidence of intracranial hemorrhage with thrombolysis is <3% and compares favorably with the much higher mortality rate of 25% to ≥50% in patients with hemodynamically unstable pulmonary emboli. The benefit of thrombolysis may outweigh the risks of intracranial hemorrhage in these patients, and careful consideration for its use in these patients is warranted.

Key Words: pulmonary embolism • thrombolysis • alteplase • glioblastoma multiforme • intracranial tumor

Journal of Intensive Care Medicine, Vol. 21, No. 4, 240-245 (2006)
DOI: 10.1177/0885066606287047
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