title: [Postoperative acute pulmonary thromboembolism treated with nafamostat mesilate].
abstract: A 66-year-old woman underwent total gastrectomy. On the first postoperative day, acute pulmonary thromboembolism (PTE) with occlusion of the pulmonary trunk occurred, and the cardiovascular state became unstable. We used urokinase and heparin at lower doses. However, massive bleeding as a result of these drugs made it difficult to continue thrombolytic and anticoagulative therapies. We stopped urokinase on the second postoperative day, and started nafamostat mesilate instead of heparin on the third postoperative day. We found that the targeted activated coagulation time value (180 sec) was more easily attained by nafamostat mesilate than by heparin. We could continue anticoagulation therapy with minimal bleeding thereafter, and the patient recovered smoothly. On CT of the 19 th postoperative day, a small thrombus was observed in the right pulmonary artery.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641.
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Tsuda
authors.forename: Keisuke
authors.initials: K
authors.lastname: Yamada
authors.forename: Ken
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Eiji
authors.initials: E
authors.lastname: Nuriya
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001550:Benzamidines; D005260:Female; D005743:Gastrectomy; D006146:Guanidines / Q000627:therapeutic use*; D006801:Humans; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology; D013274:Stomach Neoplasms / Q000601:surgery
chemical_list: D000925:Anticoagulants; D001550:Benzamidines; D006146:Guanidines; C032855:nafamostat