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Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review
BACKGROUND: The requirement of postoperative bedridden and immobilization renders neurosurgical patients with higher risk of deep vein thrombosis (DVT), then more vulnerable for pulmonary thromboembolism (PTE). But silent pulmonary thromboembolism (SPTE) can be the very early stage of any typical fo...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370816/ https://www.ncbi.nlm.nih.gov/pubmed/27537590 http://dx.doi.org/10.1097/MD.0000000000004589 |
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author | Tian, Rui Gao, Jun Chen, Alof Bao, Xinjie Guan, Jian Feng, Ming Li, Yongning Ma, Wenbin Ren, Zuyuan Wang, Renzhi Wei, Junji |
author_facet | Tian, Rui Gao, Jun Chen, Alof Bao, Xinjie Guan, Jian Feng, Ming Li, Yongning Ma, Wenbin Ren, Zuyuan Wang, Renzhi Wei, Junji |
author_sort | Tian, Rui |
collection | PubMed |
description | BACKGROUND: The requirement of postoperative bedridden and immobilization renders neurosurgical patients with higher risk of deep vein thrombosis (DVT), then more vulnerable for pulmonary thromboembolism (PTE). But silent pulmonary thromboembolism (SPTE) can be the very early stage of any typical form of PTE, its diagnosis and management is therefore critical in neurosurgical departments. However, to date, perioperative SPTE has not been attached with enough attention. METHODS: Here, we report 2 cases of perioperative SPTE in the Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China. Clinical data of 2 cases was collected and analyzed. Both patients were screened by quantitative D-dimer assay and lower limbs ultrasonography, while diagnoses were made according to computed tomographic pulmonary angiography (CTPA). Therapeutic medications include heparin, low molecular weight heparin, followed by long-term anticoagulation with oral warfarin. Both cases showed significantly elevated D-dimer before and after onset of SPTE. But in 1 case, ultrasonography reported negative venous thromboembolism. CTPA confirmed all diagnosis of SPTE. Repeated CTPA after anticoagulant therapy identified therapeutic efficacy. And during the follow-up period of 5 or 6 years, both patients acquired full recovery without clinical complications. RESULTS: Significant decline of D-dimer was observed after the comprehensive management of SPTE (case 1: preop vs postop 573 vs 50 μg/L; case 2: preop vs postop 246 vs 50 μg/L). Ultrasonography was used for suspicious of DVT, while CTPA was used for confirming SPTE diagnosis. CONCLUSION: Clinicians should be aware of the importance of early recognition of SPTE. Effective management of risk factors of hyper-coagulation state should be the key to prophylaxis. And routine monitor of D-dimer as well as regular check of lower limbs ultrasonography should be standardized and included in guidelines of neurosurgical patient management. |
format | Online Article Text |
id | pubmed-5370816 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-53708162017-03-31 Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review Tian, Rui Gao, Jun Chen, Alof Bao, Xinjie Guan, Jian Feng, Ming Li, Yongning Ma, Wenbin Ren, Zuyuan Wang, Renzhi Wei, Junji Medicine (Baltimore) 7100 BACKGROUND: The requirement of postoperative bedridden and immobilization renders neurosurgical patients with higher risk of deep vein thrombosis (DVT), then more vulnerable for pulmonary thromboembolism (PTE). But silent pulmonary thromboembolism (SPTE) can be the very early stage of any typical form of PTE, its diagnosis and management is therefore critical in neurosurgical departments. However, to date, perioperative SPTE has not been attached with enough attention. METHODS: Here, we report 2 cases of perioperative SPTE in the Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China. Clinical data of 2 cases was collected and analyzed. Both patients were screened by quantitative D-dimer assay and lower limbs ultrasonography, while diagnoses were made according to computed tomographic pulmonary angiography (CTPA). Therapeutic medications include heparin, low molecular weight heparin, followed by long-term anticoagulation with oral warfarin. Both cases showed significantly elevated D-dimer before and after onset of SPTE. But in 1 case, ultrasonography reported negative venous thromboembolism. CTPA confirmed all diagnosis of SPTE. Repeated CTPA after anticoagulant therapy identified therapeutic efficacy. And during the follow-up period of 5 or 6 years, both patients acquired full recovery without clinical complications. RESULTS: Significant decline of D-dimer was observed after the comprehensive management of SPTE (case 1: preop vs postop 573 vs 50 μg/L; case 2: preop vs postop 246 vs 50 μg/L). Ultrasonography was used for suspicious of DVT, while CTPA was used for confirming SPTE diagnosis. CONCLUSION: Clinicians should be aware of the importance of early recognition of SPTE. Effective management of risk factors of hyper-coagulation state should be the key to prophylaxis. And routine monitor of D-dimer as well as regular check of lower limbs ultrasonography should be standardized and included in guidelines of neurosurgical patient management. Wolters Kluwer Health 2016-08-19 /pmc/articles/PMC5370816/ /pubmed/27537590 http://dx.doi.org/10.1097/MD.0000000000004589 Text en Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 |
spellingShingle | 7100 Tian, Rui Gao, Jun Chen, Alof Bao, Xinjie Guan, Jian Feng, Ming Li, Yongning Ma, Wenbin Ren, Zuyuan Wang, Renzhi Wei, Junji Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review |
title | Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review |
title_full | Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review |
title_fullStr | Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review |
title_full_unstemmed | Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review |
title_short | Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review |
title_sort | silent pulmonary thromboembolism in neurosurgery patients: report of 2 cases and literature review |
topic | 7100 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370816/ https://www.ncbi.nlm.nih.gov/pubmed/27537590 http://dx.doi.org/10.1097/MD.0000000000004589 |
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