Systemic thrombolysis and anticoagulation in postpartum patient with acute respiratory distress syndrome, COVID-19 and acute pulmonary embolism: a case report

  • Samuel Hotma Rotua
  • Dwisetyo Gusti Arilaksono
  • Shinta Vera Hutajulu
Keywords: COVID-19, SARS-CoV-2, Pulmonary Embolism, Thrombolysis, Postpartum, POCUS

Abstract

COVID-19 has a wide spectrum of clinical presentations, from asymptomatic cases to severe respiratory distress, multi-organ dysfunction, and death. Pulmonary embolism (PE) is the most feared and severe complication of venous thromboembolism (VTE). We present a case of a 25-year-old nonsmoker pregnant woman (gravida 2, no history of abortion/miscarriage), who underwent an elective cesarean section at 39 weeks of gestation after uneventful pregnancy. She exhibit clinical presentation of pulmonary embolism (PE) overlapping with severe COVID-19 pneumonia. The diagnosis was made based upon severe oxygen desaturation, McConnel sign finding on POCUS and elevated D-dimer level (34.19 µg/mL). Alteplase and low-molecular-weight heparin were used, which resulted in rapid clinical improvement. We should be warned about high or extremely elevated D-dimer levels and severe oxygen desaturation, as markers of severe COVID-19 pneumonia in patients with high clinical suspicion of PE. Thrombolysis could be an effective and safe therapy for PE in ARDS secondary to COVID-19. Furthermore, we underline that POCUS, despite its inherent limitations, could be a flexible diagnostic and management tool in refractory ARDS due to COVID-19.

Key words: COVID-19; SARS-CoV-2; Pulmonary Embolism; Thrombolysis; Postpartum; POCUS

Abbreviations: ARDS - Acute respiratory distress syndrome; PE - Pulmonary embolism; VTE - Venous thromboembolism; BPM – Beats per minute

Citation: Rotua SH, Arilaksono DG, Hutajulu SV. Systemic thrombolysis and anticoagulation in postpartum patient with acute respiratory distress syndrome, COVID-19 and acute pulmonary embolism: a case report. Anaesth. pain intensive care 2022;26(1):115-118.

DOI: 10.35975/apic.v26i1.1777

Received: September 13, 2021, Reviewed: November 06, 2021, Accepted: November 10, 2021

Author Biographies

Samuel Hotma Rotua

Pertamina Jaya Hospital, Jl. Jend. Ahmad Yani No.2, RT.2RW.7, Cemp. Putih Tim., Kec. Cemp. Putih, Kota Jakarta Pusat, Daerah Khusus Ibukota Jakarta 10510, Indonesia.

Dwisetyo Gusti Arilaksono

Pertamina Jaya Hospital, Jl. Jend. Ahmad Yani No.2, RT.2RW.7, Cemp. Putih Tim., Kec. Cemp. Putih, Kota Jakarta Pusat, Daerah Khusus Ibukota Jakarta 10510, Indonesia.

Shinta Vera Hutajulu

Pertamina Jaya Hospital, Jl. Jend. Ahmad Yani No.2, RT.2RW.7, Cemp. Putih Tim., Kec. Cemp. Putih, Kota Jakarta Pusat, Daerah Khusus Ibukota Jakarta 10510, Indonesia.

Published
02-07-2022
How to Cite
Rotua, S., Arilaksono, D., & Hutajulu, S. (2022). Systemic thrombolysis and anticoagulation in postpartum patient with acute respiratory distress syndrome, COVID-19 and acute pulmonary embolism: a case report. Anaesthesia, Pain & Intensive Care, 26(1), 115-118. https://doi.org/10.35975/apic.v26i1.1777
Section
Case Reports