Interest of Tenecteplase in Thrombolysis of Pulmonary Embolism: A Case Report

Abstract

Pulmonary embolism is one of the most common and serious symptoms of venous thromboembolic disease. It is a potentially fatal condition associated with significant morbidity and mortality, and because of that, rapid and effective management is very important. Fibrinolytic treatment is a major step in the therapeutic process, principally in intermediate to high-risk forms. Through this case and a review of the literature, we will discuss the interest in thrombolysis by tenecteplase in intermediate-high-risk pulmonary embolism. A 42 years old, taxi driver, chronic smoker, with a family history of treated deep vein thrombosis, was admitted with acute respiratory distress leading to the discovery of a high intermediate-risk pulmonary embolism. sPESI score was 4 points. High-sensitive cardiac troponin I was elevated to 23 times the normal value. Echocardiography revealed an acute pulmonary heart with low cardiac output at 2,24 l/min and a cardiac index of 1,25 L/min/m2, with no visualizable thrombus. The patient underwent urgent thrombolysis with tenecteplase with a very good clinical evolution. No precipitating factors were identified. Etiological investigation revealed a protein C deficiency. The patient is put on vitamin K antagonist for life with close monitoring of the INR. This case demonstrates that even though tenecteplase is not currently approved for the treatment of acute pulmonary embolism according to current guidelines, it is a promising treatment for patients with intermediate or high- risk forms with remarkable efficacy and safety.