S61 Pulmonary embolism lysis team (PELT) to guide the management of acute pulmonary embolism in the puerperium

Introduction Venous thromboembolism risk is higher in the puerperium and pulmonary embolism (PE) is a leading cause of maternal death. IV unfractionated heparin (UFH) is considered first line treatment but favourable outcomes following thrombolysis have been recorded. The ESC guidelines recommend the use of a multidisciplinary team to plan the management of these women.1 Aim To review the management and outcomes of pregnant and post-partum women admitted to a tertiary referral centre with intermediate-high risk (IHR) and high risk (HR). Method A retrospective case notes review of pregnant and post-partum patients admitted with IHR and HR PEs between 2014 and 2019. All patients were reviewed by PELT (comprising specialists in respiratory, haematology, interventional radiology and obstetric medicine in conjunction with imaging, PESI score, troponin and NT-proBNP). All treatment decisions were made in conjunction with informed patient consent. Results Seven patients with IHR or HR PE (6 pregnant and 1 post-partum) were admitted. Of these, 4 were transferred from other hospitals. Three of the patients (gestations 10/40, 22/40 and 37+4/40) received UFH alone, two (gestations 31/40 and 38/40) were treated with catheter directed thrombolysis (CDT) and one patient (gestation 22/40) received half-dose systemic thrombolysis after haemodynamic collapse. One patient presented 4 weeks post-partum and received CDT. There were no major and only one minor bleeding complications. All patients clinically improved, with resolution of echocardiographic changes and improvement in cardiac biomarkers. There was no maternal mortality. One woman who initially presented with vaginal bleeding at 10 weeks, was treated with UFH and went on to suffer a miscarriage. All other patients went on to complete pregnancy successfully. One patient who underwent CDT had an elective caesarean section during her inpatient stay. Conclusion The management of PEs in pregnancy is difficult and treatment decisions should be patient specific. Thrombolysis and CDT give good outcomes in carefully selected patients. A PELT team with the input of Obstetric Medicine specialists is invaluable in making these decisions. Reference Konstantinides, et al. 2019. ‘ESC Guidelines for the diagnosis and management of the acute pulmonary embolism developed in collaboration with the ERS’. ERJ. Vol 56Issue 2.