{
  "abstract": "High-risk pulmonary embolism (PE) with severe thrombocytopenia creates competing reperfusion and bleeding risks. A 28-year-old man presented with obstructive shock and central pulmonary arterial filling defects. The last documented platelet count before alteplase was 21 × 10⁹/L; platelet transfusion intervened, and the count at infusion initiation was unknown. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) and hemostatic support were instituted. With increasing vasoactive requirements, the team selected bedside systemic thrombolysis after multidisciplinary consideration of surgical and catheter-based alternatives. Unfractionated heparin was paused at the first 20-mg alteplase infusion at 17:00. Arterial cannulation-site bleeding at 17:20 was treated with compression. The progress note documented that bleeding had stopped by 19:03; despite reduced vasoactive requirements, support dependence persisted. A second 20-mg infusion began at 19:25. Each stage lasted approximately 1 h. Heparin was restarted after the second infusion. Vasopressors were stopped on Day 1 and VA-ECMO was removed on Day 7. Hemoglobin fell from 150 to 117 g/L on Day 0 and reached 75 g/L on Day 8, prompting red-cell transfusion. Major bleeding could not be excluded. The patient was discharged on Day 19; Day 103 imaging showed no obvious residual pulmonary arterial filling defect. This case describes individualized decisions during multimodal care, not a validated alteplase regimen or evidence of its safety.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Respiratory Medicine, Linyi People's Hospital",
    "Department of Radiology, Linyi People's Hospital",
    "Emergency Department, Linyi People's Hospital",
    "Respiratory Intensive Care Unit, Linyi People's Hospital"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Le Kang"
    },
    {
      "affs": [
        1
      ],
      "name": "Yanfei Lin"
    },
    {
      "affs": [
        2
      ],
      "name": "Shuai Wang"
    },
    {
      "affs": [
        3
      ],
      "name": "Xia Ji"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a3r410vp8dq8c.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.1977983",
  "fulltext_url": "https://europepmc.org/articles/PMC13687056",
  "id": "a3r410vp8dq8c",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1977983/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2724|Venous Thromboembolism Diagnosis and Management"
    ]
  ],
  "openalex": "W7220917919",
  "pdf_url": "https://europepmc.org/articles/PMC13687056?pdf=render",
  "pmcid": "PMC13687056",
  "pmid": "42923273",
  "published": "2026-10-08",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/a3r410vp8dq8c.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.3389/fcvm.2026.1977983",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1977983/full"
    },
    {
      "first_seen": "2026-10-30T12:20:36Z",
      "native_id": "MED:42923273",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42923273"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2297-055X",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Case Report: Staged alteplase administration under VA-ECMO support for high-risk pulmonary embolism with severe thrombocytopenia",
  "title_text": "Case Report: Staged alteplase administration under VA-ECMO support for high-risk pulmonary embolism with severe thrombocytopenia",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:36Z",
  "url": "https://research.draconitic.com/paper/a3r410vp8dq8c",
  "venue": "Frontiers in Cardiovascular Medicine",
  "versions": []
}