Early postoperative thrombolytic therapy after laparotomy

Abstract

Early postoperative pulmonary embolism due to deep venous thrombosis has been reported to be associated with a mortality rate of approximately 46%. Administration of thrombolytic drugs is relatively contraindicated during this period so that conservative or surgical treatment can be considered as a therapeutical intervention. We report the case of a 68-year-old male patient who was subjected to systemic thrombolytic therapy due to pulmonary embolism on the first day after laparatomy.

Sumàrio

A embolia pulmonar post operatória precoce na sequência de trombose venosa profunda tem sido descrita como associada a uma mortalidade de 46%. O tratamento trombolı́tico é uma contra-indicação relativa pelo que, nesta fase, se considera a possibilidade tratamento conservador ou cirúrgico. Relatamos o caso de um homem de 68 anos que foi tratado com trombolı́ticos por embolia pulmonar no 1° dia post laparotomia.

Introduction

Deep venous thrombosis with subsequent cardiac and pulmonary embolism (PE) remains a serious complication after surgical procedures. The incidence varies with both the surgical procedure and preexisting risk factors and is reported to occur in 0.5–0.7% with a mortality rate of 40–60% [1], [2]. Systemic thrombolytic therapy for acute symptomatic pulmonary embolism is relatively contraindicated during the early postoperative phase due to the high risk of bleeding but decisions should be based on the relative risk versus benefit for that particular patient [3], [4]. Several investigators and clinicians have reported the use of intravenous thrombolysis for pulmonary embolism during the late postoperative phase yet (8–33 days postoperatively) [5].