[Postoperative acute pulmonary thromboembolism treated with nafamostat mesilate]

A 66-year-old woman underwent total gastrectomy. On the first postoperative day, acute pulmonary thromboembolism (PTE) with occlusion of the pulmonary trunk occurred, and the cardiovascular state became unstable. We used urokinase and heparin at lower doses. However, massive bleeding as a result of these drugs made it difficult to continue thrombolytic and anticoagulative therapies. We stopped urokinase on the second postoperative day, and started nafamostat mesilate instead of heparin on the third postoperative day. We found that the targeted activated coagulation time value (180 sec) was more easily attained by nafamostat mesilate than by heparin. We could continue anticoagulation therapy with minimal bleeding thereafter, and the patient recovered smoothly. On CT of the 19 th postoperative day, a small thrombus was observed in the right pulmonary artery.