also rarely manifest as spontaneous hemothorax [4-6]. All these cases experienced hemothorax within 2 days after tPA administration, a shorter period compared with those who experienced hemothorax after anticoagulation therapy only.
In the present case, hemothorax occurred shortly after tPA administration and heparinization, indicating that it may have resulted from combined thrombolytic and anticoagulant therapy inducing overanticoagulation.
Moreover, the patient was of a relatively low body weight, which may have been a cofactor in the bleeding event. Although the standard dose of tPA is 100 mg, adjustment of fibrinolytic dose should be considered in patients less than 70 kg.
Massive hemothorax induced by thrombolytic agent and anticoagulation
for PE is extremely rare. Nevertheless, physicians should
suspect hemothorax if patients experience chest pain, dyspnea, or
signs of anemia following anticoagulant and/or thrombolytic therapy,
performing follow-up physical examination and hemogram to
facilitate diagnosis of this life-threatening complication