Introduction
Acute pulmonary thromboembolism is a life-threatening cardiovascular
condition with high mortality. In intermediate risk pulmonary embolism
(PE), management strategy may include catheter-directed (CD)
thrombolysis in addition to systemic anticoagulation. Immediate systemic
thrombolysis is considered if clinical deterioration and shock ensues.
When hemodynamically stable, heparin infusion is the mainstay of
therapeutic anticoagulation with potential complications.
Heparin-induced thrombocytopenia (HIT) is a rare but potentially fatal,
antibody-mediated adverse drug reaction of heparin therapy. It occurs
among 1% of hospitalized patients receiving heparin and the mortality
rate is as high as 20% [1]. We present the unusual clinical course
a patient with acute intermediate risk bilateral pulmonary thromboemboli
who developed HIT and required additional management strategies due to
rapid conditional change.