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Paradoxical Worsening of Shock After the Use of a Percutaneous Mechanical Thrombectomy Device in a Postpartum Patient With a Massive Pulmonary Embolism*

Nidhi Kumar, MD; Yelena Janjigian, MD; David R. Schwartz, MD
Author and Funding Information

*From the Department of Medicine, New York University Medical Center, New York, NY.

Correspondence to: Nidhi Kumar, MD, Department of Medicine, New York University Medical Center, 550 1st Ave, NBV 16N 26, New York, NY 10016; e-mail: kumarn01@med.nyu.edu.



Chest. 2007;132(2):677-679. doi:10.1378/chest.06-1082
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Major pulmonary embolism (PE), defined as PE presenting with shock, has a mortality rate of nearly 60%.1 Effective therapy for PE leading to obstructive shock must reduce pulmonary arterial clot burden in order to decrease right ventricular afterload and reverse right ventricular failure. While different strategies to reduce or remove thrombus have not been compared to each other, or to control, in clinical trials, both systemic thrombolysis and surgical thrombectomy have been used successfully in this setting. These interventions are associated with significant morbidity. In the largest reported registry of patients with acute PE, those treated with systemic thrombolysis had a 3% incidence of intracranial hemorrhage and a major bleeding rate of 21.7%.1 Classically, open surgical embolectomy, reserved for patients with severe hemodynamic compromise and contraindications to systemic thrombolysis, had an average hospital mortality rate of 30%.2 Two reports34 of relatively small single-center experiences with open embolectomy for massive PE (approximately 30% of patients with shock) document hospital mortality rates < 10%.

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