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An Important Dilemma: Fibrinolytic Treatment in Bleeding Diathesis

Published online by Cambridge University Press:  07 October 2020

Mustafa Emin Canakci Open the ORCID record for Mustafa Emin Canakci [Opens in a new window] ,
Volkan Ercan Open the ORCID record for Volkan Ercan [Opens in a new window] ,
Nurdan Acar Open the ORCID record for Nurdan Acar [Opens in a new window]  and
Serdar Efe Open the ORCID record for Serdar Efe [Opens in a new window]
Mustafa Emin Canakci*
Affiliation:
Emergency Department, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
Volkan Ercan
Affiliation:
Intensive Care Unit, Eskisehir City Hospital, Eskisehir, Turkey
Nurdan Acar
Affiliation:
Emergency Department, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
Serdar Efe
Affiliation:
Intensive Care Unit, Eskisehir City Hospital, Eskisehir, Turkey
*
Correspondence: Mustafa Emin Canakci, MD Emergency Department Eskisehir Osmangazi University School of MedicineEskisehir, Turkey Prof. Dr. Nabi Avcı Boulevard, No:4, Meselik, Odunpazarı, 26040 E-mail: mustafaeminc@gmail.com
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Abstract

Pulmonary embolism is a clinical condition with high mortality rates in all age groups. The treatment includes anticoagulation and fibrinolytic therapy, and clinical management is challenging in cases of bleeding diathesis. Sepsis-induced coagulopathy (SIC), which has been recently defined to cause disruption of coagulation cascade accompanied by organ dysfunctions, is regarded as a major cause of mortality. It is noteworthy that there is no decrease in fibrinogen levels, unlike disseminated intravascular coagulopathy (DIC). This study aimed to present the management of a 70-year-old female patient who was admitted to emergency department with atypical complaints and diagnosed with pulmonary embolism due to deep vein thrombosis and septic shock. The clinical success of fibrinolytic therapy following the administration of fresh frozen plasma (FFP), although the patient had elevated international normalized ratio (INR), is presented in this case report. Since elevated INR and thrombocytopenia, which are observed in SIC, are caused by the inhibition of fibrinolysis, fibrinolytic therapy can be a rational treatment choice considering the profit/loss rate.

Keywords

fibrinolytic treatmentfresh frozen plasmapulmonary embolismultrasonography
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 6 , December 2020 , pp. 690 - 692
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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