Unexpected bilateral massive pulmonary embolism

Rheumatoid arthritis may be complicated by venous thrombotic disease with up to 33% of cases being associated with antiphospholipid syndrome [1]. Antiphospholipid antibodies may have precipitated the events in our patient. When the patient's condition deteriorated, we resorted to thrombolytic therapy. There are clear indications for the administration of thromobolytic agents. The most recent recommendations from the American College of Chest Physicians [2] advise its use with evidence of hemodynamic compromise in the absence of contraindications to therapy, ideally via a peripheral vein, and utilizing a regimen with a short infusion time. There is less robust evidence to support the use of thrombolytics for high-risk, normotensive patients assessed to have a low bleeding risk, but outside these conditions, thrombolytics are not recommended.The author declares no competing interests.