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Management of pulmonary embolism after recent intracranial hemorrhage: A case report
RATIONALE: Venous thromboembolism may result from prolong immobilization following intracerebral hemorrhage. Massive pulmonary embolism with associated right heart failure is life-threatening, requiring treatment with anticoagulants or even thrombolytic agents. However, these drugs are contraindicat...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908629/ https://www.ncbi.nlm.nih.gov/pubmed/29642222 http://dx.doi.org/10.1097/MD.0000000000010479 |
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author | Lee, Wei-Chieh Fang, Hsiu-Yu |
author_facet | Lee, Wei-Chieh Fang, Hsiu-Yu |
author_sort | Lee, Wei-Chieh |
collection | PubMed |
description | RATIONALE: Venous thromboembolism may result from prolong immobilization following intracerebral hemorrhage. Massive pulmonary embolism with associated right heart failure is life-threatening, requiring treatment with anticoagulants or even thrombolytic agents. However, these drugs are contraindicated after a recent hemorrhagic episode, as they may induce further hemorrhage. There are no guidelines for treatment in these circumstances. PATIENT CONCERNS: A 57-year-old man experienced massive pulmonary embolism and shock 18 days after an intracerebral hemorrhage. DIAGNOSES: Tachycardia and high D-dimer (21.27 mg/L fibrinogen-equivalent units) were noted. Chest computed tomography showed bilateral pulmonary trunk embolism. INTERVENTIONS: Heparinization were used and activated partial thromboplastin time therapeutic range was 50 to 70 seconds. Fortunately, shock status and shortness of breath improved two days later. Continuing high dose Rivaroxaban was administrated for three weeks. OUTCOMES: There was no recurrent intracranial hemorrhage (ICH) following treatment for three-weeks with high-dose and one-year with standard dose of rivaroxaban. This report presents a treatment option in the management of these difficult clinical situations. LESSONS: The combination of unfractionated heparin infusion and continuing non-Vitamin K antagonist oral anticoagulants use could manage life-threatening pulmonary embolism following recent ICH. Theoretically, the use of NOAC is a safer strategy if the patient with previous history of major ICH. |
format | Online Article Text |
id | pubmed-5908629 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-59086292018-04-30 Management of pulmonary embolism after recent intracranial hemorrhage: A case report Lee, Wei-Chieh Fang, Hsiu-Yu Medicine (Baltimore) 3400 RATIONALE: Venous thromboembolism may result from prolong immobilization following intracerebral hemorrhage. Massive pulmonary embolism with associated right heart failure is life-threatening, requiring treatment with anticoagulants or even thrombolytic agents. However, these drugs are contraindicated after a recent hemorrhagic episode, as they may induce further hemorrhage. There are no guidelines for treatment in these circumstances. PATIENT CONCERNS: A 57-year-old man experienced massive pulmonary embolism and shock 18 days after an intracerebral hemorrhage. DIAGNOSES: Tachycardia and high D-dimer (21.27 mg/L fibrinogen-equivalent units) were noted. Chest computed tomography showed bilateral pulmonary trunk embolism. INTERVENTIONS: Heparinization were used and activated partial thromboplastin time therapeutic range was 50 to 70 seconds. Fortunately, shock status and shortness of breath improved two days later. Continuing high dose Rivaroxaban was administrated for three weeks. OUTCOMES: There was no recurrent intracranial hemorrhage (ICH) following treatment for three-weeks with high-dose and one-year with standard dose of rivaroxaban. This report presents a treatment option in the management of these difficult clinical situations. LESSONS: The combination of unfractionated heparin infusion and continuing non-Vitamin K antagonist oral anticoagulants use could manage life-threatening pulmonary embolism following recent ICH. Theoretically, the use of NOAC is a safer strategy if the patient with previous history of major ICH. Wolters Kluwer Health 2018-04-13 /pmc/articles/PMC5908629/ /pubmed/29642222 http://dx.doi.org/10.1097/MD.0000000000010479 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | 3400 Lee, Wei-Chieh Fang, Hsiu-Yu Management of pulmonary embolism after recent intracranial hemorrhage: A case report |
title | Management of pulmonary embolism after recent intracranial hemorrhage: A case report |
title_full | Management of pulmonary embolism after recent intracranial hemorrhage: A case report |
title_fullStr | Management of pulmonary embolism after recent intracranial hemorrhage: A case report |
title_full_unstemmed | Management of pulmonary embolism after recent intracranial hemorrhage: A case report |
title_short | Management of pulmonary embolism after recent intracranial hemorrhage: A case report |
title_sort | management of pulmonary embolism after recent intracranial hemorrhage: a case report |
topic | 3400 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908629/ https://www.ncbi.nlm.nih.gov/pubmed/29642222 http://dx.doi.org/10.1097/MD.0000000000010479 |
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