PMID- 14500078
OWN - NLM
STAT- MEDLINE
DCOM- 20040121
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 24
IP  - 4
DP  - 2003 Oct
TI  - Successful management of acute pulmonary embolism after surgery for lung cancer.
PG  - 580-7
AB  - OBJECTIVE: Although many case reports of acute pulmonary embolism (APE) have been 
      published, the literature dealing with the management of APE after resection of 
      lung cancer is limited. This report describes seven cases of successful 
      management of APE after surgery for lung cancer and discusses how to manage this 
      problematic complication. METHODS: The medical charts of seven patients with APE 
      after lobectomy and complete mediastinal lymphnode dissection were 
      retrospectively reviewed. RESULTS: Six patients collapsed during their first 
      attempt at walking after surgery in conjunction with a dramatic respiratory 
      change. All these patients promptly underwent enhanced spiral computed tomography 
      (CT) scanning. Bilateral clots were detected in all patients and one patient with 
      a deep venous thrombus (DVT) in the femoral vein had a temporary inferior vena 
      cava filter implanted. Non-surgical therapy was used for six patients: 
      thrombolysis (systemic urokinase) and anticoagulant (heparin or argatroban) for 
      four patients and only anticoagulant therapy started on the day after the 
      operation using argatroban for two. There were no bleeding problems with these 
      thrombolysis and/or anticoagulant therapies except in one case of hemorrhage 
      induced by heparin usage on the day after the operation. None of the cases 
      required allotransfusion in connection with these therapies. Thromboembolectomy 
      was performed for one patient who was hemodynamically unstable due to massive 
      embolism and primary atrial fibrillation. All patients were discharged from our 
      hospital without major complications. CONCLUSIONS: Patients with pulmonary 
      embolism after surgery for lung cancer can be treated aggressively with 
      anticoagulants with/without fibrinolitics or even with pulmonary embolectomy on 
      cardiopulmonary bypass, without excessive risk of bleeding complications. 
      Enhanced spiral CT scanning was very helpful for making a simultaneous diagnosis 
      of APE and DVT. The use of argatroban in conjunction with activated clotting time 
      monitoring should be effective without causing bleeding problems during the early 
      stages after pulmonary resection for lung cancer.
FAU - Sakuragi, Toru
AU  - Sakuragi T
AD  - Department of Thoracic and Cardiovascular Surgery, Saga Medical School, 5-1-1 
      Nabeshima, Saga 849-8501, Japan. sakurat@post.saga-med.ac.jp
FAU - Sakao, Yukinori
AU  - Sakao Y
FAU - Furukawa, Kojiro
AU  - Furukawa K
FAU - Rikitake, Kazuhisa
AU  - Rikitake K
FAU - Ohtsubo, Satoshi
AU  - Ohtsubo S
FAU - Okazaki, Yukio
AU  - Okazaki Y
FAU - Natsuaki, Masafumi
AU  - Natsuaki M
FAU - Itoh, Tsuyoshi
AU  - Itoh T
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Anticoagulants/therapeutic use
MH  - Female
MH  - Humans
MH  - Lung Neoplasms/*surgery
MH  - Lymph Node Excision
MH  - Male
MH  - Middle Aged
MH  - Pneumonectomy/*adverse effects
MH  - Pulmonary Embolism/diagnostic imaging/*drug therapy/etiology
MH  - Retrospective Studies
MH  - Thrombolytic Therapy
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
RF  - 25
EDAT- 2003/09/23 05:00
MHDA- 2004/01/22 05:00
CRDT- 2003/09/23 05:00
PHST- 2003/09/23 05:00 [pubmed]
PHST- 2004/01/22 05:00 [medline]
PHST- 2003/09/23 05:00 [entrez]
AID - S1010794003003920 [pii]
AID - 10.1016/s1010-7940(03)00392-0 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2003 Oct;24(4):580-7. doi: 
      10.1016/s1010-7940(03)00392-0.