Background: Initial assessment of acute Pulmonary Embolism (PE) is essential in risk stratification into low-risk and high-risk (massive) Pulmonary embolism as per the hemodynamic stability. Patients with sub-massive PE who are likely to progress for hemodynamic instability should receive anticoagulation and should be monitored. 

Methodology: This is a descriptive case report of a 45-year-old female who presented with history of nonproductive cough for 2 weeks, associated with retrosternal chest pain and shortness of breath. On physical exam her vitals were: temp 38.1 degrees Celsius, Blood Pressure 160/106mmhg, SPO2 84% on room air, pulse 113b/min, R/R 26 cycles/min. She had distended neck veins with vigorous pulsation seen JVP 10mmhg. On auscultation there was reduced air entry and a systolic murmur in left sternal border, D dimer >6000ng/dl (0-500ng/dl), cardiac troponin 0.6ng/ml. Computerized tomography pulmonary angiogram (CTPA) revealed bilateral pulmonary emboli in the right and left pulmonary arteries and an echo suggestive of severe pulmonary arterial hypertension with a peak value of > 70mmhg with preserved left ventricular ejection fraction (LVEF) 57%.  

Results: Thrombolysis with half-dose Tenecteplase (20 mg infusion over 30 minutes) was well tolerated, with no bleeding complications observed. The patient’s clinical status improved rapidly, including normalization of vital signs and oxygen saturation, and she was discharged on the fourth day in stable condition with ongoing anticoagulation therapy. 

Discussion: Half-dose thrombolysis with Tenecteplase has shown to improve pulmonary perfusion resulting in improved clinical symptoms and a short hospital stay with minimal chance for bleeding issues. Patients with sub massive PE at highest risk for progression to hemodynamic instability should receive anticoagulation and be monitored for clinical deterioration. 

Conclusion: Low-dose Tenecteplase is therefore a safe and efficacious treatment option for sub massive PE as denoted. However, larger randomized controlled trials are needed to establish low-dose Tenecteplase as an accepted treatment modality.

Edmond Nyaribo Kimaiga is a Kenyan clinical medicine professional, educator, and researcher with interests in cardiology, emergency medicine, and critical care. He is currently pursuing a Master’s degree in Emergency and Critical Care at Mount Kenya University.He holds a Bachelor’s degree in Clinical Medicine and Surgery, a Higher Diploma in Cardiology, and a Diploma in Clinical Medicine and Surgery. His research interests focus on cardiovascular emergencies.

He has published a case report titled “Role of Half-Dose Tenecteplase in the Management of Sub massive Pulmonary Embolism.” Currently, he serves as a Lecturer at the Kenya Medical Training College (KMTC), Faculty of Clinical Sciences, Department of Clinical Medicine, where he is involved in teaching, mentorship, and clinical training of healthcare students. He continues to contribute to medical education and research aimed at improving emergency and cardiovascular care in Kenya.