Kedong Zhang1, Xiansheng Zeng1, Caixia Zhu2, Lei Xu1, Xin Fu1, Hua Jiang1, Jian Wang3, Wenju Lu4. 1. Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, People's Republic of China. 2. Department of Rheumatology, The General Hospital, Ningxia Medical University, Ningxia, People's Republic of China. 3. Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, People's Republic of China; Division of Pulmonary & Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21224, United States. Electronic address: jwang31@jhmi.edu. 4. Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, People's Republic of China; Division of Pulmonary & Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21224, United States. Electronic address: wlu92@yahoo.com.
Abstract
PURPOSE: The standard medical management for patients with acute massive pulmonary embolism (MPE) is systemic thrombolysis. However, it is generally thought that recent surgeries are a contraindication to thrombolytic therapy. In this study, we evaluated the efficacy and safety of systemic thrombolysis for postoperative patients with acute MPE and assessed the risk of bleeding. METHODS: A retrospective review was performed on 21 postoperative patients with MPE in a timeframe of five years (from 2005 to 2010). The criteria for study inclusion were postoperative patients who received systemic thrombolysis for confirmed acute MPE within three weeks after surgery. RESULTS: Seventeen postoperative patients, including men (12) and women (five) aged 53±16 (range 23-71) years, were treated with systemic thrombolysis. Significant haemodynamic improvement (shock index<0.9) was observed in 16 of 17 cases (94%). The remaining patient (6%) died of cardiac arrest within 24h. No major bleeding complication was observed. Sixteen patients survived and remained stable for 34±16 (range 11-52) days until hospital discharge. CONCLUSION: Recent surgery is not an absolute contraindication to systemic thrombolysis. Further, to obtain a successful outcome, it is crucial to exclude patients who have received neurosurgical operations or those with other contraindications to thrombolytic therapy.
PURPOSE: The standard medical management for patients with acute massive pulmonary embolism (MPE) is systemic thrombolysis. However, it is generally thought that recent surgeries are a contraindication to thrombolytic therapy. In this study, we evaluated the efficacy and safety of systemic thrombolysis for postoperative patients with acute MPE and assessed the risk of bleeding. METHODS: A retrospective review was performed on 21 postoperative patients with MPE in a timeframe of five years (from 2005 to 2010). The criteria for study inclusion were postoperative patients who received systemic thrombolysis for confirmed acute MPE within three weeks after surgery. RESULTS: Seventeen postoperative patients, including men (12) and women (five) aged 53±16 (range 23-71) years, were treated with systemic thrombolysis. Significant haemodynamic improvement (shock index<0.9) was observed in 16 of 17 cases (94%). The remaining patient (6%) died of cardiac arrest within 24h. No major bleeding complication was observed. Sixteen patients survived and remained stable for 34±16 (range 11-52) days until hospital discharge. CONCLUSION: Recent surgery is not an absolute contraindication to systemic thrombolysis. Further, to obtain a successful outcome, it is crucial to exclude patients who have received neurosurgical operations or those with other contraindications to thrombolytic therapy.
Authors: Robin Condliffe; Charlie A Elliot; Rodney J Hughes; Judith Hurdman; Rhona M Maclean; Ian Sabroe; Joost J van Veen; David G Kiely Journal: Thorax Date: 2013-12-16 Impact factor: 9.139