Ahmed Rizq/LinkedIn
Jul 5, 2026, 21:05
Ahmed Rizq: Would You Thrombolyse a Stable Patient?
Ahmed Rizq, Cardiologist, shared a post on LinkedIn:
“Would you thrombolyse a stable patient?
A 30-year-old male presented with acute dyspnea.
no medical history
Key findings:
- CT pulmonary angiography: Massive pulmonary embolism
- Echocardiography: Severe right ventricular dilatation and dysfunction
- Mobile right heart thrombus (thrombus in transit)
- Interestingly, the patient was hemodynamically stable at presentation (no shock).
This creates a challenging clinical scenario:
A high-risk anatomical burden (right heart thrombus with massive PE) in a clinically stable patient.
Management dilemma:
Systemic thrombolysis vs Catheter-directed therapy vs Surgical embolectomy vs Anticoagulation alone with close monitoring
Key question:
Does the presence of a thrombus in transit alone justify escalation to thrombolysis even in the absence of shock?
Would value colleagues’ approaches and experience.”
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