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Thrombolytic therapy for postoperative pulmonary embolism
J E Molina1, D W Hunter, J W Yedlicka
1Department of Surgery, University of Minnesota, Minneapolis.
American Journal of Surgery
|April 1, 1992
Summary
This study presents a novel protocol for treating recent postoperative pulmonary embolism using urokinase and heparin. The new method successfully lysed clots in all patients without complications, offering a safe alternative for high-risk individuals.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Postoperative pulmonary embolism (PE) poses a significant clinical challenge due to the contraindication of thrombolytic therapy in patients with recent surgery.
- Existing treatment guidelines present a dilemma for managing PE in the early postoperative period.
Purpose of the Study:
- To develop and evaluate a safe and effective protocol for treating pulmonary embolism in patients who have recently undergone surgery.
- To assess the efficacy and safety of a direct urokinase infusion combined with heparin for acute PE in this high-risk population.
Main Methods:
- A protocol was established involving direct catheter-directed urokinase injection into the pulmonary artery clot, followed by continuous infusion.
- Heparin was administered concurrently, with serum fibrinogen levels monitored to prevent bleeding complications.
- Thirteen patients with angiographically confirmed PE within 14 days of surgery were treated.
Main Results:
- Complete lysis of pulmonary emboli was achieved in all thirteen patients.
- No deaths or bleeding complications were reported during the treatment period.
- Two patients required inferior vena cava filters, and nine patients discontinued chronic anticoagulation within three months.
Conclusions:
- The developed protocol for direct urokinase infusion is a safe and effective treatment for acute pulmonary embolism in patients with recent surgical history.
- This approach offers a viable alternative to systemic thrombolysis or anticoagulation alone, potentially reducing long-term complications.