Double Thrombolysis with rt-PA in a Patient with Massive Pulmonary Embolism and Antiphospholipid Syndrome

T he antiphospholipid syndrome is an autoimmune disease, characterized by the presence of antiphospholipid antibodies, thromboses, repeat spontaneous abortions and thrombocytopenia. The syndrome may be encountered in patients without any clinical or laboratory indications of other systemic disease (primary), or may be encountered within the context of other systemic disease – more often with Systemic Lupus Erythematosus (secondary). The most common clinical manifestations are venous thromboses of the lower limbs, of pulmonary arteries as well as of other vessels (cerebral, renal, etc.) and repeat spontaneous abortions. The treatment of the antiphospholipid syndrome, depends on the location of the thrombosis and the severity of symptoms. We describe a case of a patient with antiphospholipid syndrome with positive antibodies against cardiolipin and lupus anticoagulant, massive pulmonary embolism, deep venous thrombosis of the left lower limb and aggravated personal history (diabetes mellitus, hypothyroidism due to thyroidectomy, hypertension) who underwent thrombolysis treatment (with rt-PA) twice, due to insufficient clinical and laboratory improvement, following the first thrombolysis session.