Zero anticoagulation, zero thrombolysis: successful management of massive pulmonary embolism following hemorrhagic transformation of acute ischemic stroke: a case report

TL;DR

A 78-year-old woman with a brain bleed and severe lung clot was successfully treated without using blood thinners or clot-busting drugs.

Contribution

Demonstrates the success of mechanical thrombectomy without anticoagulation or thrombolysis in a complex clinical scenario.

Findings

Mechanical thrombectomy stabilized the patient's condition without worsening the intracranial hemorrhage.

The zero-anticoagulation strategy avoided increasing the risk of brain bleeding.

This case supports mechanical intervention as a viable option in high-risk pulmonary embolism cases.

Abstract

The treatment of patients with severe pulmonary embolism complicated by intracerebral hemorrhage is challenging: anticoagulation or thrombolysis, essential for treating pulmonary embolism, can substantially worsen intracranial hemorrhage and threaten life.

We report a case of a 78-year-old female who developed hemorrhagic transformation following acute ischemic stroke, complicated by massive pulmonary embolism and rapidly progressing to shock. In this case, emergent percutaneous mechanical thrombectomy was successfully performed under a zero-anticoagulation and zero-thrombolysis strategy, resulting in hemodynamic stabilization.

This case provides valuable evidence supporting the feasibility of purely mechanical percutaneous intervention in high-risk, complex clinical scenarios.

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