Aspiration Thrombectomy for High-Risk Pulmonary Embolism With Life-Threatening Anemia and Active Uterine Bleeding: A Case Report.
- 1Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China.
- 2Hebei Key Laboratory of Pathogenic Mechanisms and Diagnosis & Treatment Technologies for Lung Microbiome, First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China.
Abstract
BACKGROUND High-risk pulmonary embolism (PE) carries significant mortality, and management becomes complex when it coexists with severe anemia and active bleeding, as thrombolysis is then contraindicated. We report the case of a patient with high-risk PE complicated by severe anemia (hemoglobin 41 g/L) and active uterine bleeding from adenomyosis. CASE REPORT A 48-year-old woman presented with haemodynamic instability (blood pressure 74/47 mm Hg), critical anemia (hemoglobin 41 g/L), and a 3-year history of irregular vaginal bleeding from adenomyosis. Computed tomography (CT) pulmonary angiography confirmed bilateral PE with right pulmonary artery main-trunk occlusion; echocardiography showed severe pulmonary hypertension, and duplex ultrasound showed extensive left lower-limb deep vein thrombosis. Thrombolysis was contraindicated. Emergency percutaneous aspiration thrombectomy was performed using large-bore catheters (22F, 20F, 16F) with concurrent inferior vena cava filter placement, reducing pulmonary artery pressure from 51/23 to 34/12 mm Hg; the estimated blood loss, quantified from filtered aspirate, was approximately 100 mL. Adjuncts included transfusion of 13 units of packed red cells, dilatation and curettage, gonadotropin-releasing hormone agonist therapy, and titrated anticoagulation. At discharge after a 24-day hospitalization she was hemodynamically stable, and free of dyspnea, with resolved edema and hemoglobin 72 g/L, on oral rivaroxaban. CONCLUSIONS In this thrombolysis-contraindicated patient, aspiration thrombectomy with inferior vena cava filter placement was a feasible rescue strategy that achieved rapid hemodynamic and angiographic improvement without thrombolysis, with palliative rather than curative intent. As a single case, it cannot establish comparative safety or efficacy, and broader conclusions regarding efficacy cannot be drawn. It illustrates a potentially useful approach in similarly complex scenarios where coordinated multidisciplinary care is essential.
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BibTeX
@article{saoudi2026aspiration,
title = {{Aspiration Thrombectomy for High-Risk Pulmonary Embolism With Life-Threatening Anemia and Active Uterine Bleeding: A Case Report.}},
author = {Okba Saoudi and Bu Wang},
journal = {The American journal of case reports},
year = {2026},
month = oct,
doi = {10.12659/ajcr.954225},
url = {https://europepmc.org/article/MED/42902551},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Aspiration Thrombectomy for High-Risk Pulmonary Embolism With Life-Threatening Anemia and Active Uterine Bleeding: A Case Report.
AU - Okba Saoudi
AU - Bu Wang
PY - 2026
DA - 2026/10/21
JO - The American journal of case reports
DO - 10.12659/ajcr.954225
UR - https://europepmc.org/article/MED/42902551
AB - BACKGROUND High-risk pulmonary embolism (PE) carries significant mortality, and management becomes complex when it coexists with severe anemia and active bleeding, as thrombolysis is then contraindicated. We report the case of a patient with high-risk PE complicated by severe anemia (hemoglobin 41 g/L) and active uterine bleeding from adenomyosis. CASE REPORT A 48-year-old woman presented with haemodynamic instability (blood pressure 74/47 mm Hg), critical anemia (hemoglobin 41 g/L), and a 3-year history of irregular vaginal bleeding from adenomyosis. Computed tomography (CT) pulmonary angiography confirmed bilateral PE with right pulmonary artery main-trunk occlusion; echocardiography showed severe pulmonary hypertension, and duplex ultrasound showed extensive left lower-limb deep vein thrombosis. Thrombolysis was contraindicated. Emergency percutaneous aspiration thrombectomy was performed using large-bore catheters (22F, 20F, 16F) with concurrent inferior vena cava filter placement, reducing pulmonary artery pressure from 51/23 to 34/12 mm Hg; the estimated blood loss, quantified from filtered aspirate, was approximately 100 mL. Adjuncts included transfusion of 13 units of packed red cells, dilatation and curettage, gonadotropin-releasing hormone agonist therapy, and titrated anticoagulation. At discharge after a 24-day hospitalization she was hemodynamically stable, and free of dyspnea, with resolved edema and hemoglobin 72 g/L, on oral rivaroxaban. CONCLUSIONS In this thrombolysis-contraindicated patient, aspiration thrombectomy with inferior vena cava filter placement was a feasible rescue strategy that achieved rapid hemodynamic and angiographic improvement without thrombolysis, with palliative rather than curative intent. As a single case, it cannot establish comparative safety or efficacy, and broader conclusions regarding efficacy cannot be drawn. It illustrates a potentially useful approach in similarly complex scenarios where coordinated multidisciplinary care is essential.
SN - 1941-5923
ER -