The birth of a new baby should be a magical time for new parents, but for Natasha, a young South African woman, the dream turned into a nightmare two days after the safe delivery of her daughter by Caesarian section.  While still in hospital, Natasha suffered a pulmonary embolism, or PE, a potentially life-threatening condition caused by a blood clot getting trapped in the lungs and blocking blood flow in the pulmonary artery that feeds the heart.  If not recognized and treated promptly, a PE can lead to long-term damage to the function of the heart, heart attack and even death.  

What is a pulmonary embolism (PE)? 

A PE usually originates as a clot (or thrombus) that forms in the leg as a deep-vein thrombosis (DVT) before being carried to the lungs in the bloodstream.  While these rogue blood clots most commonly occur in people over 60¹, there are certain situations that increase the risk of them forming in younger age groups – airline travel is perhaps the best known of these, with passengers nowadays encouraged to exercise their legs and ankles to maintain circulation while during flights.  Less well known are the risks associated with pregnancy and the first few weeks after giving birth, but in fact PE is a leading cause of maternal mortality in the developed world.^2,3 

Why are pregnant women and new mothers more at risk? 

A variety of factors combine to create this risk – the main one being that as soon as a woman becomes pregnant, the make-up of her blood starts to change, increasing its ability to clot quickly in order to minimise the amount of blood she will lose during childbirth. However, the relative risk of an unwanted, dangerous clot spontaneously forming in the venous circulation also increases; in the few weeks after childbirth, this risk is approximately 20-fold higher than for a woman of the same age who has not just had a baby.⁴ In Natasha’s case, the fact her daughter had been delivered by Caesarian – a surgical procedure – would have further increased the need for her blood to clot to help her heal, making her risk of PE even higher. 

What happened in Natasha’s case? 

Natasha describes waking up and feeling as if someone was sitting on her chest and that she was struggling to breathe. She was given oxygen and moved to the critical care department, where she received intravenous anticoagulation (blood-thinning) drugs and closely monitored.  However, it soon became clear that she was not responding to this treatment, with regular echocardiograms showing that the strain on her heart was increasing due to the compromised blood supply. Given this deterioration, her doctors organized for her to undergo an emergency procedure using a specialist device that had only recently been introduced to the hospital.  

The EKOS™ Acoustic Thrombolysis System is a minimally invasive (non-surgical) system for dissolving thrombus.  It uses an innovative catheter and transducer to simultaneously deliver ultrasonic waves and a thrombolytic (“clot-busting”) drug directly into the PE. The acoustic field created by the ultrasound unwinds and thins out the dense, tangled mesh of fibrin that forms the clot, speeding up the distribution and penetration of the thrombolytic drug, and significantly reducing the time it takes to work.  In Natasha’s case, it made all the difference - within a few hours, she could breathe more easily and her vital signs and the strain on her heart were showing improvement.  She says she felt as if “A weight had been lifted off her chest”. 

Without EKOS™, Natasha’s story could have had a very different ending 

Her doctor, Dr Mariusz Tarkowski, emphasises  how important it is to have access to the EKOS System for high-risk patients like Natasha, “What is great about this new technology is that we are now able to treat the type of patients that we have previously only offered supportive therapy to…In the case of Natasha, any other modality would have almost certainly had a bad effect on her right-sided heart function, her livelihood and quality-of-life going forward, but apart from that, it would have certainly kept her in hospital for a prolonged period of time”.  Instead, Natasha was able to return home within a few days and has been able to enjoy spending time with her daughter and husband as she regains full fitness.  She says she feels like she has a new lease of life, knowing how close she came to having it taken away from her.   

Natasha was indeed very lucky; EKOS acoustic pulse technology only became available in South Africa in 2022. Boston Scientific acquired the EKOS™ technology in 2018 and since has been working to make the technology more available to more patients in different markets.  

“New technology is revolutionising the way we treat pulmonary embolism, leading to improved patient outcomes and saving lives,” commented Xavier Bertrand, vice president EMEA, Peripheral Interventions at Boston Scientific.  “we continue to drive innovation and enable access for new medical technologies.”    

The lack of awareness surrounding maternal PE increases the risks it presents 

While access to the right technology to treat high-risk PE is essential, Natasha’s story also highlights the need to raise awareness among healthcare professionals and the general public of the risks and symptoms of dangerous blood clots in pregnant women and new mothers.  Appropriate treatment relies on prompt and accurate diagnosis and established protocols that require multi-disciplinary awareness and co-operation.  A 2020 study found that PE-related deaths in hospitalized pregnant women represented 14% of all maternal deaths in Germany and concludes with a pressing call to action.  

“Better preventive and management strategies should be urgently implemented in this vulnerable patient group.”³ 

Find about the latest advancements in thrombosis  https://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/venous-thromboembolism-portal/whats-new.html