Clinical Report: Effective Intervention for Critical Acute Pulmonary Embolism

Background

Acute perioperative pulmonary embolism (APE) is a significant complication in elderly patients, particularly those with major fractures requiring prolonged immobilization. The risk of venous thromboembolism (VTE) increases with age and is exacerbated by comorbidities and delays in surgical intervention. Understanding the management of APE is crucial for improving outcomes in this vulnerable population. Recent studies indicate that advanced age is a powerful independent risk factor for preoperative deep vein thrombosis (DVT), driven by a hypercoagulable state and systemic inflammation.

Data Highlights

No numerical data or trial data available in the source material, which limits the generalizability of the findings.

Key Findings

• The patient exhibited a profound hypercoagulable state prior to anesthesia induction.
• Sudden cardiovascular collapse occurred immediately after induction, with new-onset atrial fibrillation and right bundle branch block.
• Bedside echocardiography confirmed right ventricular enlargement due to massive APE.
• Emergency low-dose systemic thrombolysis (50 mg alteplase) was successfully administered.
• Post-thrombolysis evaluations indicated consumptive coagulopathy and transient anemia, managed with supportive care.
• The patient achieved complete clinical recovery at one-year follow-up.

Clinical Implications

Intraoperative monitoring using point-of-care ultrasound and ECG is essential for early detection of APE in high-risk patients. However, the risks associated with low-dose systemic thrombolysis should be carefully considered.

Conclusion

This case highlights the need for rapid recognition and intervention in cases of APE during anesthesia induction.

Related Resources & Content

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4. Tailored Approaches for Managing High-Risk Acute Pulmonary Embolism: A Response to the 'Catastrophic' Subgroup Discussion, Intensive Care Medicine, 2025 -- Tailored Approaches for Managing High-Risk Acute Pulmonary Embolism
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6. Acute Intraoperative Pulmonary Embolism Management in the Era of Pulmonary Embolism Response Teams and Minimally Invasive Therapy: A Case Report
7. Risk Factors for Preoperative DVT in Elderly Patients with Hip Fractures | MDPI
8. First AHA/ACC acute pulmonary embolism guideline: prompt diagnosis and treatment are key - American College of Cardiology