In the management of pulmonary embolism, thrombolysis is contraindicated in patients within 10 days of major surgery. Which option would be contraindicated in such a patient?

• A. Thrombolysis
• B. Anticoagulation
• C. Embolectomy
• D. Inferior vena cava filter

Answer: (A)

Thrombolysis is contraindicated because providing clot-busting therapy soon after major surgery carries a high risk of serious bleeding at the surgical site and other sites. Within about 10 days of surgery, wound healing is incomplete, so systemic fibrinolysis can lead to postoperative hemorrhage, wound dehiscence, or other catastrophic bleeding. That danger makes thrombolysis unsafe in this setting.

Alternatives to treat PE when thrombolysis is not an option include anticoagulation to prevent new clots, surgical embolectomy if the patient is unstable or thrombolysis isn’t feasible, and an inferior vena cava filter to reduce recurrence risk when anticoagulation is contraindicated or ineffective.