Massive pulmonary embolism complicating mild Covid 19 pneumonia: Successful systemic thrombolysis using rt-PA in an elderly patient: A case report

Introduction: and importance: Pulmonary embolism (PE) is still a major health concern around the world, and its link with SARS Cov-2 has led to an increase in morbidity, mortality, and ICU hospitalizations.

Case presentation: We present the case of a 92-year-old man with no prior medical history who admitted to our hospital in a state of acute respiratory failure, echocardiography revealed an acute right heart syndrome with a thrombus in the right atrium, computed tomography pulmonary angiogram revealed bilateral massive pulmonary embolism as well as Covid-19 pneumonia. He was treated with systemic thrombolysis using intravenous rt-PA (recombinant tissue plasminogen activator) with immediate clinical improvement and no hemorrhagic complications.

Clinical discussion: In the presence of the SARs Cov-2 infection, several reports have indicated considerable procoagulant events, including life-threatening pulmonary embolism. There are still no current guidelines for the treatment of VTE in COVID-19 patients, but they are largely consistent with non-COVID-19 recommendations. Elderly patients are considered to be at high risk of developing thromboembolic complications, and also and above all are vulnerable to bleeding complications from anticoagulant treatments.

Conclusion: This case highlight the importance of considering thromboembolic complications despite the severity of the associated SARS-cov-2 pneumonia and the role of prophylactic anticoagulation for Covid-19 patients hospitalized or not.