Successful thrombolysis in postoperative patients with acute massive pulmonary embolism.
OBJECTIVE
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.


CONCLUSIONS
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.
Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, People's Republic of China.
Kedong
K
Zhang
Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, People's Republic of China.
Xiansheng
X
Zeng
Department of Rheumatology, The General Hospital, Ningxia Medical University, Ningxia, People's Republic of China.
Caixia
C
Zhu
Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, People's Republic of China.
Lei
L
Xu
Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, People's Republic of China.
Xin
X
Fu
Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, People's Republic of China.
Hua
H
Jiang
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.
Jian
J
Wang
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.
Wenju
W
Lu
D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy*; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator