CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2018; 05(02): 108-110
DOI: 10.1055/s-0038-1654752
Case Report
Indian Society of Neuroanaesthesiology and Critical Care

Systemic Intravenous Thrombolysis for Massive Pulmonary Embolism after Intracranial Surgery for Traumatic Head Injury: When Absolute Becomes Relative!

Varun Jain
1   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
Harsh Sapra
2   Department of Neuroanaesthesiology and Critical Care, Medanta—The Medicity, Gurugram, Haryana, India
Deepak Bhangale
3   Department of Neurosurgery, Medanta—The Medicity, Gurugram, Haryana, India
› Author Affiliations
Further Information

Publication History

Received: 21 February 2018

Accepted: 21 April 2018

Publication Date:
12 May 2018 (online)


Intravenous thrombolysis is the preferred treatment for massive pulmonary embolism with hemodynamic instability, when there are no contraindications to the therapy. However, when absolute contraindications to thrombolysis are present, clinicians are at a crux, especially when mechanical thrombectomy is also not possible. We present a case of a 40-year-old man with polytrauma with head injury who developed massive pulmonary embolism requiring intravenous thrombolysis on day 15 after decompressive craniotomy—possibly a first in the literature. The patient, however, successfully recovered from this near-fatal episode. With this report, we wish to highlight that at a near-dying situation, no contraindication is absolute, and all possible efforts must be made by the clinician to save the patient.