title: Pulmonary thromboembolism in lung surgery: use of unfractionated heparin.
abstract: BACKGROUND
  While thoracic surgeons occasionally encounter pulmonary thromboembolism, the use of unfractionated heparin may cause adverse effects.
  
  
  METHODS
  We assessed a series of 323 consecutive pulmonary operations performed during 4 years from 2008 to 2011. All patients were given elastic stockings and intermittent pneumatic compression. During the first 2 years (2008-2009), none of the 169 patients received unfractionated heparin. In the second 2-year period (2010-2011), 135/154 patients received subcutaneous unfractionated heparin, either 5000 units (n = 37) or 2500 units (n = 93) twice daily for 3 days, or continuous intravenous unfractionated heparin (n = 5). The epidural catheters were withdrawn 6 h or more after unfractionated heparin use. Among patients without postoperative unfractionated heparin, 8 (42.1%) had a bleeding risk and 5 (26.3%) had limited operative time.
  
  
  RESULTS
  One (0.6%) patient developed pulmonary thromboembolism during 2008-2009, but none had this complication during 2010-2011. The adverse outcome of intrathoracic bleeding occurred in one (2.7%) of the patients given 5000 units of unfractionated heparin, but no epidural hematomas occurred in these patients.
  
  
  CONCLUSIONS
  Patients undergoing thoracic surgery at low risk of bleeding may receive unfractionated heparin to prevent pulmonary thromboembolism while avoiding epidural complications.
authors.affiliation: Department of Chest Surgery, Shimonoseki City Hospital, Shimonoseki, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Yoshida
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inoue
authors.forename: Koichi
authors.initials: K
authors.lastname: Furugaki
authors.forename: Mayumi
authors.initials: M
authors.lastname: Oyama
authors.forename: Keigo
authors.initials: K
authors.lastname: Oozono
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Anesthesia epidural; Heparin; Intermittent pneumatic compression devices; Pulmonary embolism; Pulmonary surgical procedures; Stockings; compression