Recommended Citation
Paolella G, Bikeyeva V, Bentsen C, Cho D, Adams J, Labchuk A, Winnicki K, Chaus A, Patel P. Massive pulmonary embolism in acromegaly: a perfect storm of thrombotic risk. Poster presented at: 11th Annual Pulmonary Embolism Scientific Symposium (PERT Consortium); September 2025; San Diego, CA.
Presentation Notes
Poster presented at: 11th Annual Pulmonary Embolism Scientific Symposium (PERT Consortium); San Diego, CA
Abstract
Purpose: To describe a case of massive pulmonary embolism (PE) in a patient with acromegaly and multiple prior venous thromboembolic (VTE) events who was perioperative, emphasizing the hypercoagulable risk and management challenges. Background: Acromegaly, characterized by elevated insulin-like growth factor-1, may predispose patients to thrombotic events via endothelial dysfunction and procoagulant changes. Data linking acromegaly to venous thromboembolism (VTE) are limited, but recurrent events are clinically significant, especially when anticoagulation is interrupted perioperatively. Methods: A 64-year-old male with acromegaly secondary to a pituitary microadenoma (s/p gamma knife) and a history of multiple VTE events presented for elective substernal thyroidectomy and parotidectomy. Anticoagulation with rivaroxaban was held for 48 hours preoperatively. On post operative day one, he suffered a witnessed cardiac arrest while ambulating. Return of spontaneous circulation was achieved after one round of cardiopulmonary resuscitation. Results: Post-arrest evaluation revealed acute bilateral PE with severe right ventricular (RV) dysfunction. Given recent surgery, systemic thrombolysis was deferred. The patient underwent catheter-directed thrombectomy with partial improvement but remained in RV failure requiring vasopressors, inhaled nitric oxide, and milrinone. He was transferred for possible extracorporeal membrane oxygenation support but improved with medical management. He was discharged on warfarin with home health, and hematology recommended indefinite anticoagulation. Inferior vena cava (IVC) filter placement was advised if anticoagulation interruption is ever required again. Conclusion: This case highlights the thrombotic risk in patients with acromegaly and recurrent VTE, especially in perioperative settings. Interruption of anticoagulation, even briefly, may result in life-threatening events. Prophylactic strategies, including bridging or IVC filters, should be considered in select high-risk patients.
Type
Poster
Affiliations
Advocate Lutheran General Hospital