Anaphylaxis to Tissue Plasminogen Activator in the Treatment of Pulmonary Embolism: A Case Report of Mixed Shock Management

Acute pulmonary embolism (PE) impairs gas exchange and pulmonary circulation, which can progress to acute right ventricular failure, obstructive shock, and death. Pulmonary embolism is one of the leading causes of cardiovascular mortality, and the reported annual incidence rates are between 39 and 115 per 100 000 population.¹  Because of the severity and fast onset of pulmonary embolism, many patients die suddenly or within hours of an acute PE. Early recognition and treatment are paramount to avoiding death associated with PE.² 

Classification of PE severity guides therapeutic approaches and prognostic evaluation. The 2019 European Society of Cardiology (ESC) guidelines provide severity classifications based on hemodynamic stability, right ventricle (RV) dysfunction, positive cardiac enzymes (troponin), and Pulmonary Embolism Severity Index (PESI) scoring.²  The PESI scoring system consists of 11 parameters, including patient characteristics and vital signs, to stratify patients with a PE into 5 severity classes based on...