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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...

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Autores principales: Tian, Rui, Gao, Jun, Chen, Alof, Bao, Xinjie, Guan, Jian, Feng, Ming, Li, Yongning, Ma, Wenbin, Ren, Zuyuan, Wang, Renzhi, Wei, Junji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
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.
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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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