[The recurrence of pulmonary embolism during heparin therapy after thrombolysis in the acute phase: a clinical case report].
We report a case of a 61-year-old woman admitted to our Coronary Care Unit for pulmonary embolism following cholecystectomy. After thrombolytic therapy, and during treatment with heparin (administered as a continuous intravenous infusion in the standard dose), the patient had a recurrence of pulmonary embolism and a subsequent implant of a Gianturco-Rohem vena cava filter. The patient presented an initial reduction in the number of platelets from 477 x 10(3)/microliters to 360 x 10(3)/microliters that was ascribed to a heparin side effect or to a blocking of the platelets in a massive pulmonary thrombosis. A predischarge platelet count, however, showed an elevated number of thrombocytes (944 x 10(3)/microliters) and hyperfibrinogenemia (fibrinogen = 750 mg/dl). Essential thrombocythemia was demonstrated and treated with interferon alpha-2b-recombinant 3,000,000 U.I. on alternate days with a reduction in platelets to 450 x 10(3)/microliters. This case demonstrates the necessity of exploring, during pulmonary embolism, all possible causes of hypercoagulability in the course of thrombolytic therapy.
Fornaro
G
G
Divisione di Cardiologia, Ospedale Maggiore, Novara.
Sansa
M
M
Dellavesa
P
P
Cernigliaro
C
C
D000208:Acute Disease; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy*; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012008:Recurrence; D013920:Thrombocythemia, Essential / Q000209:etiology / Q000628:therapy; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016306:Vena Cava Filters
D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D006493:Heparin; D010959:Tissue Plasminogen Activator
Recidiva di embolia polmonare in corso di terapia eparinica dopo trombolisi in fase acuta: descrizione di un caso clinico.