{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:44:03Z","timestamp":1791477843375,"version":"4.3.4"},"reference-count":35,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Pulmonary embolism (PE) is a major cause of cardiovascular mortality, particularly in high-risk cases complicated by hemodynamic instability. Systemic thrombolysis is the recommended treatment in such settings; however, the coexistence of thrombocytopenia represents a major therapeutic challenge due to concerns regarding bleeding risk. Evidence guiding thrombolytic therapy in thrombocytopenic patients with PE is limited. This study aimed to present a representative case and review the available literature addressing thrombolysis in PE complicated by thrombocytopenia. Methods: A qualitative review of published case reports was conducted using the PubMed and Scopus databases, and articles describing adult patients with objectively confirmed PE, documented thrombocytopenia, and treatment with thrombolytic therapy were included. Eight case reports met the inclusion criteria, and the clinical characteristics, severity markers, platelet dynamics, treatment strategies and outcomes were analyzed and compared with the reported case. Results: Most of the reported patients presented with high-risk pulmonary embolism, defined by hemodynamic instability, including shock or cardiac arrest. Thrombolysis was frequently administered despite platelet counts below conventional thresholds. Platelet levels at the time of thrombolysis varied widely, including cases of severe thrombocytopenia. Clinical and hemodynamic improvement was observed in most of the cases, while major bleeding complications were infrequent. The reported case demonstrated successful systemic thrombolysis with rt-PA in a postpartum patient with suspected heparin-induced thrombocytopenia and high-risk PE, without hemorrhagic events. Conclusions: Available evidence suggests that thrombolytic therapy may be a viable life-saving option in carefully selected thrombocytopenic patients with high-risk pulmonary embolism. Therapeutic decisions should prioritize clinical severity and hemodynamic status over platelet count alone, emphasizing individualized, multidisciplinary risk\u2013benefit assessment.<\/jats:p>","DOI":"10.3390\/jcm15072569","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T12:45:53Z","timestamp":1774615553000},"page":"2569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Thrombolytic Therapy in High-Risk Pulmonary Embolism with Thrombocytopenia: Case Report and Literature Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Marciana Ionela","family":"Boca","sequence":"first","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"},{"name":"Doctoral School Medicine-Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina-Ramona","family":"Cozlac","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"},{"name":"Advanced Research Center of the Institute for Cardiovascular Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Department VI Cardiology-Cardiovascular Surgery, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caius Glad","family":"Streian","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"},{"name":"Advanced Research Center of the Institute for Cardiovascular Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Department VI Cardiology-Cardiovascular Surgery, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8760-5605","authenticated-orcid":false,"given":"Simina","family":"Crisan","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"},{"name":"Advanced Research Center of the Institute for Cardiovascular Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Department VI Cardiology-Cardiovascular Surgery, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai-Andrei","family":"Lazar","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"},{"name":"Advanced Research Center of the Institute for Cardiovascular Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Department VI Cardiology-Cardiovascular Surgery, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela-Daniela","family":"Virtosu","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"},{"name":"Doctoral School Medicine-Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0173-3617","authenticated-orcid":false,"given":"Raluca Elisabeta","family":"Staicu","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Iliescu","sequence":"additional","affiliation":[{"name":"Department of Surgery I\u2014Clinic of Surgical Semiotics & Thoracic Surgery, Center for Hepato-Biliary and Pancreatic Surgery, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin-Tudor","family":"Luca","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, G. Adam Str. No. 13A, 300310 Timisoara, Romania"},{"name":"Advanced Research Center of the Institute for Cardiovascular Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Department VI Cardiology-Cardiovascular Surgery, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy of Timi\u0219oara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E774","DOI":"10.1161\/CIR.0000000000000707","article-title":"Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association","volume":"140","author":"Giri","year":"2019","journal-title":"Circulation"},{"key":"ref_2","first-page":"101258","article-title":"Epidemiology of Pulmonary Embolism in China, 2021: A Nationwide Hospital-Based Study","volume":"54","author":"Zhen","year":"2025","journal-title":"Lancet Reg. 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