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Compartment syndrome following thrombolysis: clinical features and associated conditions
Martin Freyer1, Ivana Vachalova, Benedikt Zirngibl
1Department of Neurology, Municipal Hospital Landshut, Robert-Koch Str. 1, 84034, Landshut, Germany.
Insights
Compartment syndrome (CS) is a rare but serious adverse event following thrombolysis. Predisposing factors include limb manipulation, fractures, and aggressive antithrombotic therapy, necessitating prompt surgical intervention.
Area of Science:
- Vascular Surgery
- Thrombolytic Therapy
- Adverse Event Monitoring
Background:
- Thrombolysis is crucial for treating thrombotic events but carries risks.
- Hemorrhagic complications are well-documented, but other adverse events like compartment syndrome (CS) are less understood.
- This study systematically reviews CS as a complication of thrombolysis.
Observation:
- A systematic literature review identified 24 patients with thrombolysis-associated CS.
- Common thrombolytic agents included rtPA, streptokinase, and urokinase.
- CS most frequently affected the upper limb (15 cases) and lower limb (9 cases).
Findings:
- Predisposing factors identified were limb manipulations (15 cases), hidden fractures (2 cases), and concurrent antithrombotic therapy (15 cases).
- The median time to CS diagnosis was 12 hours.
- Surgical fasciotomy was the primary treatment, with favorable outcomes in 14 cases, but persistent nerve damage occurred in 5, and amputation in 2.
Implications:
- Compartment syndrome following thrombolysis is a rare but significant complication.
- Awareness of predisposing factors is crucial for early detection and management.
- Further research may elucidate optimal strategies to mitigate this risk in patients receiving thrombolytic therapy.
Abstract:
Major complications of thrombolysis are intracranial and extracranial bleedings. Compartment syndrome (CS) as a serious adverse event is sparsely reported. The purpose of the study is to present a systematic review of the literature on this complication based on a case vignette. A PubMed and Google Scholar search on CS following thrombolysis was performed. Twenty-four patients (11 male, 11 female, 2 not noted; median age 66 years, range 19-85 years) with thrombolysis associated CS were identified. Fifteen patients had thrombolysis with rtPA, 4 patients with streptokinase, 3 patients with urokinase, and 2 patients with tenecteplase. In 15 cases, CS affected the upper limb, and in 9 cases the lower limb. Indication for thrombolysis was myocardial infarction in 11 patients, arterial occlusion of the leg in 6 patients, pulmonary embolism in 4 patients, stroke in 2 patients, and deep venous thrombosis in 1 patient. In addition, in 15 cases, aspirin/ticlopidin, and/or heparin in therapeutic dosages had been prescribed. In 15 cases manipulations of the affected limb had been preceding. In both stroke patients, a hidden fracture was later diagnosed. The median time to the diagnosis of CS was 12 h (2 h-3 days). Therapy was mostly surgical with fasciotomy. The outcome of CS was favorable in 14 cases. However, in 5 cases, nerve damage persisted, and amputation was indicated in 2 patients. CS following thrombolysis is a rare condition. As predisposing factors different manipulations, hidden fracture and pronounced antithrombotic therapy are encountered.
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