title: Successful thrombolysis after pulmonary embolectomy for persistent massive postoperative pulmonary embolism.
abstract: Massive postoperative pulmonary embolism (PE) is associated with a poor prognosis in patients presenting with haemodynamic instability. Since recent surgery is a commonly accepted contraindication for thrombolytic therapy, pulmonary embolectomy is an appropriate therapeutic approach in these patients. If life-threatening symptoms of PE persist after pulmonary embolectomy, however, very few other therapeutic options are available. We report the successful use of locally administered low-dose thrombolysis 2 days after pulmonary embolectomy in a patient with postoperative PE and persistent severe hypoxaemia and pulmonary hypertension. During and after thrombolysis, no bleeding complications occurred. We conclude that low-dose thrombolysis for PE may be considered even in patients who have recently undergone major thoracic and abdominal surgery if embolectomy and continued intravenous heparin have failed to be successful and life-threatening symptoms of PE persist.
authors.affiliation: Department of Anaesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. fabian_spoehr@med.uni-heidelberg.de
authors.forename: Fabian
authors.initials: F
authors.lastname: Spöhr
authors.forename: Georg C
authors.initials: GC
authors.lastname: Rehmert
authors.forename: Bernd W
authors.initials: BW
authors.lastname: Böttiger
authors.forename: Siegfried
authors.initials: S
authors.lastname: Hagl
authors.forename: André
authors.initials: A
authors.lastname: Gries
mesh_terms: D000368:Aged; D017128:Embolectomy; D006801:Humans; D008297:Male; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000628:therapy*; D011655:Pulmonary Embolism / Q000628:therapy*; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator