Case reportMassive pulmonary embolism treated with a reduced dose of alteplase in a patient with acute renal failure

There are some doubts whether in a severe renal failure the dose of alteplase should not be modified, especially when its plasma clearence may be decreased by liver ischemia. The authors present a case of a 67-year old woman with massive pulmonary embolism (PE) and acute renal failure (creatinine 580 µmol/l) of a mixed etiology (renal calculosis with hydronephrosis and shock as PE presentation). Alteplase administration (10 mg bolus followed by reduced to 50 mg two hours infusion) resulted in hemodynamic stabilization but was complicated by gross subcutaneous hematomas, intensive epistaxis and hematuria, and hemoglobin decrease which required blood transfusions

Chorzy trudni typowiStosowanie doustnych środków antykoncepcyjnych zwiększa ryzyko powikłań zakrzepowo-zatorowych nawet małego zabiegu chirurgicznego

A case of a 25-year-old woman with life-threatening pulmonary embolism, which occurred on fourth day after appendectomy and was safely treated with alteplase infusion. Before surgery, oral contraceptive use history, as a sole venous thromboembolic risk factor has been missed and the patient did not receive perioperative, pharmacologic antithrombotic prophylaxis. Further screening for thrombophilia was negative. This case proves that contraceptives use may create, irrespectively of the woman age, a possibility of perioperative thromboembolic complications, even for such minor procedure as appendectomy

Case reportMassive pulmonary embolism in a patient with ulcerative colitis and hyperhomocysteinemia – a case report

We describe a case of a 37-year-old man with active ulcerative colitis complicated by proximal deep vein thrombosis of the left lower limb and subsequent massive pulmonary embolism requiring mechanical ventilation and catecholamine infusion. In spiral CT a large thrombus obturating left pulmonary artery as well as bilateral embolic material in lobar and segmental branches were visible. Haemodynamic status improved after infusion of rtPA. Haemoglobin decrease (7.0–5.6 mmol/L) was corrected with erythrocyte mass transfusion. During subsequent therapy with intravenous full dose of unfractionated heparin and further long-term treatment with subcutaneous enoxaparin (1.5 mg/kg and after 3 months 1.0 mg/kg daily) haemoglobin value was relatively stable. Underlying disease was treated with 5-ASA (mesalazine) and steroids. Due to hyperhomocysteinaemia (16.0 µmol/L) coexisting with a low plasma folic acid (2.1 ng/ml) and cyanocobalamin (137 pg/ml) levels, supplementation with these vitamins was prescribed. The screening tests for familial thrombophilia (including 677C→T MTHFR mutation) were negative. The authors discuss the pathogenesis of increased thromboembolic risk in inflammatory bowel disease and therapeutic dilemmas connected with treatment of such complications