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Background <p>Massive pulmonary embolism (PE) may present as sudden cardiac arrest and requires immediate reperfusion therapy. However, systemic thrombolysis carries a substantial risk of catastrophic bleeding, particularly in patients with unrecognized gynecologic pathology or underlying prothrombotic conditions. The coexistence of malignancy, thrombophilia, and life-threatening hemorrhage presents complex diagnostic and therapeutic challenges.</p> Case description <p>A 54-year-old woman with abnormal uterine bleeding collapsed from cardiac arrest due to massive PE. Return of spontaneous circulation was achieved following systemic thrombolysis with recombinant tissue plasminogen activator. Shortly thereafter, she developed uncontrolled uterine hemorrhage with an estimated blood loss of nearly 4 liters, requiring massive transfusion. An inferior vena cava filter was placed to prevent recurrent embolization. Emergency surgical management with total hysterectomy and bilateral salpingo-oophorectomy successfully controlled the bleeding. Postoperative thrombophilia evaluation revealed reduced natural anticoagulants and a borderline lupus anticoagulant. Histopathological examination demonstrated early-stage, low-grade endometrial carcinoma confined to the endometrium. The patient recovered uneventfully and remained free from recurrent thromboembolism or malignancy during follow-up.</p> Conclusion <p>This case illustrates the dual hazards of systemic thrombolysis in the setting of occult gynecologic malignancy and underlying thrombophilia. Prompt recognition of uncontrolled bleeding, decisive surgical intervention, and comprehensive thrombophilia evaluation are crucial in managing cancer-associated massive PE. Multidisciplinary coordination is essential to optimize outcomes in this rare but life-threatening clinical scenario.</p>

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Bleeding Risks in Cancer-associated PE: An Endometrial Carcinoma Case Study

  • 期刊论文

  • 发表日期：

    2026年4月9日

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  • Ingporn Jiamset,
  • Punchalee Kaenmuang,
  • Rakchai Buhachat,
  • Pattharapa Watcharasin,
  • Thitisak Vanichpakorn,
  • Santikorn Gorsagun

摘要

Background

Massive pulmonary embolism (PE) may present as sudden cardiac arrest and requires immediate reperfusion therapy. However, systemic thrombolysis carries a substantial risk of catastrophic bleeding, particularly in patients with unrecognized gynecologic pathology or underlying prothrombotic conditions. The coexistence of malignancy, thrombophilia, and life-threatening hemorrhage presents complex diagnostic and therapeutic challenges.

Case description

A 54-year-old woman with abnormal uterine bleeding collapsed from cardiac arrest due to massive PE. Return of spontaneous circulation was achieved following systemic thrombolysis with recombinant tissue plasminogen activator. Shortly thereafter, she developed uncontrolled uterine hemorrhage with an estimated blood loss of nearly 4 liters, requiring massive transfusion. An inferior vena cava filter was placed to prevent recurrent embolization. Emergency surgical management with total hysterectomy and bilateral salpingo-oophorectomy successfully controlled the bleeding. Postoperative thrombophilia evaluation revealed reduced natural anticoagulants and a borderline lupus anticoagulant. Histopathological examination demonstrated early-stage, low-grade endometrial carcinoma confined to the endometrium. The patient recovered uneventfully and remained free from recurrent thromboembolism or malignancy during follow-up.

Conclusion

This case illustrates the dual hazards of systemic thrombolysis in the setting of occult gynecologic malignancy and underlying thrombophilia. Prompt recognition of uncontrolled bleeding, decisive surgical intervention, and comprehensive thrombophilia evaluation are crucial in managing cancer-associated massive PE. Multidisciplinary coordination is essential to optimize outcomes in this rare but life-threatening clinical scenario.