Successful catheter-directed thrombolysis for high-risk submassive pulmonary embolism in a pregnant patient post-large ovarian cystectomy: a case report and multidisciplinary approach

Background: High-risk submassive pulmonary embolism (PE) during pregnancy especially 3rd trimester, presents a significant challenge, with the physiological changes of pregnancy increasing the risk of venous thromboembolism (VTE) and PE being a leading cause of maternal mortality. Catheter-directed thrombolysis (CDT) offers a targeted thrombolytic approach, potentially minimizing systemic bleeding risks compared to systemic thrombolysis, making it a viable option in select pregnant patients with high-risk submassive PE.1,2 Case report: We present a case of a 29-year-old pregnant woman at 27 weeks gestation who developed acute bilateral PE two days after undergoing a laparotomy for a large ovarian mass excision. A multidisciplinary Pulmonary Embolism Response Team (PERT) evaluation recommended ultrasound-assisted CDT using a tissue plasminogen activator (tPA). The patient showed significant post-procedure improvement, delivered a healthy infant via Cesarean section at term, and had no long-term complications. Conclusion: This case emphasizes the efficacy and safety of CDT for managing high-risk submassive PE during pregnancy, particularly after recent major surgery. The multidisciplinary approach, especially a dedicated PERT, in optimizing maternal and fetal outcomes in such complex scenarios proved effective in ensuring both maternal and fetal safety, leading to favorable outcomes.3,4