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Ahmed Rizq: Would You Thrombolyse a Stable Patient?
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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