Clinical analysis on the combination of low molecular weight heparin and warfarin for acute pulmonary thromboembolism after thoracotomy_West China Medical Journal

Authors：

 XUEYang , DIAOMingqiang , LüJing , HONGLan

Department of Cardiothoracic Surgery, People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding?author：

XUEYang, Email: 26917269@qq.com

Keywords：

Thoracic surgery; Pulmonary embolism; Low molecular weight heparin; Warfarin

DOI：

10.7507/1002-0179.201510208

Video：

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Objective To investigate the diagnosis and treatment of pulmonary thromboembolism (PTE) after thoracotomy. Methods We analyzed the clinical data of 10 patients with PTE after thoracotomy treated from January 2011 to March 2015. Among them were 8 males and 2 females, with their age ranging from 51 to 73 years old, averaging 61. Six patients had lung cancer lobectomy, and 4 had esophagus carcinoma resection. All the 10 patients suffered sudden shortness of breath, chest pain and palpitation within the first 40 hours to 128 hours after surgery, and the physical examinations revealed tachypnea, drop of blood pressure and tachycardia. The PTE diagnosis was confirmed after using echocardiography, three-dimensional imaging of CT pulmonary angiography. All the patients accepted the treatment combination of low molecular weight heparin and warfarin. Results All the patients were cured without complications like chest or wound bleeding. Follow-up checks 3 months after the surgery showed no relapses. Conclusions Thoracotomy patients are of high risks of PTE. The diagnosis should be based on imaging examinations. Treatment combination of low molecular weight heparin and warfarin has a remarkable effect in treating PTE patients after thoracotomy, which also has a low rate of bleeding complications.

Citation： XUEYang, DIAOMingqiang, LüJing, HONGLan. Clinical analysis on the combination of low molecular weight heparin and warfarin for acute pulmonary thromboembolism after thoracotomy. West China Medical Journal, 2017, 32(1): 5-7. doi: 10.7507/1002-0179.201510208 Copy

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13.	Hirsh J, Fuster V, Ansell J, et al. American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. J Am Coll Cardiol, 2003, 41(9): 1633-1652.
14.	李建華, 沈學東. 華法林治療左心房血栓的療效. 新藥與臨床, 1995, 14(5): 300-301.
15.	張學義, 張薇, 黎莉, 等. 華法林溶解左心耳血栓機制的研究. 中國老年學雜志, 2005, 25(3): 256-257.
16.	Corrado G, Tadeo G, Beretta S, et al. Atrial thrombi resolution after prolonged anticoagulation in patients with atrial fibrillation. Chest, 1999, 115(1): 140-143.
17.	Bates SM, Ginsberg JS. Treatment of deep-veinthrombosis. N Engl J Med, 2004, 35(1): 268-277.
18.	Hyers TM, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease. Chest, 2001, 119(Suppl): 176S-193S.
19.	王兆鉞. 血栓與止血研究的的現狀與發展趨勢——第二十屆國際血栓與止血大會內容介紹與分析. 中華血液學雜志, 2006, 27(3): 215-216.

1. ?柳志紅, 趙彥芬. 急性肺栓塞的診斷治療現狀. 中國循環雜志, 2002, 17(3): 169-170.
2. 劉心甜, 劉成偉, 吳明祥, 等. 肺栓塞溶栓與抗凝治療的療效及出血風險對比研究. 中國心血管雜志, 2013, 18(1): 21-24.
3. Roberts GW, Druskeit T, Jorgensen LE, et al. Comparison of an age adjusted warfarin loading protocol with empirical dosing and Fennerty’s protocol. Aust N Z J Med, 1999, 29(5): 731-736.
4. Clagett GP, Andersson FA, Levine MN, et al. Prevention of venous thromboembolism. Chest, 1992, 102(4 Suppl): 391S-407S.
5. Collins R, Scrimgeour A, Yusuf S, et al. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. N Engl J Med, 1988, 318: 1162-1173.
6. Johnson MJ, Sproule MW, Paul J. The prevalence and associated variables of deep venous thrombosis in patients with advanced cancer. Clin Oncol (R Coll Radiol), 1999, 11(2): 105-110.
7. Ziomek S, Read RC, Tobler HG, et al. Thromboembolism in patients undergoing thoracotomy. Ann Thorac Surg, 1993, 56(2): 223-226.
8. 程顯聲. 肺栓塞的臨床表現與初步診斷. 中華心血管病雜志, 2001, 29(5): 262-263.
9. Konstantinides S, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Revista Espa?ola de Cardiología (English Edition), 2015, 68 (1): 64.
10. 林梓卿, 吳同果, 郭曉碧, 等. 低分子肝素治療急性肺栓塞療效分析. 實用醫學雜志, 2008, 24(4): 640-642.
11. Buller HR. Treatment of symptomatic venous thromboembolism: improving outcomes. Semin Thromb Hemost, 2002, 28(Suppl 2): 41-48.
12. 殷亞昕, 夏云峰, 劉潤梅, 等. 不同治療方法對老年肺血栓栓塞癥預后的影響. 中華老年心腦血管病雜志, 2008, 10(10): 754-756.
13. Hirsh J, Fuster V, Ansell J, et al. American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. J Am Coll Cardiol, 2003, 41(9): 1633-1652.
14. 李建華, 沈學東. 華法林治療左心房血栓的療效. 新藥與臨床, 1995, 14(5): 300-301.
15. 張學義, 張薇, 黎莉, 等. 華法林溶解左心耳血栓機制的研究. 中國老年學雜志, 2005, 25(3): 256-257.
16. Corrado G, Tadeo G, Beretta S, et al. Atrial thrombi resolution after prolonged anticoagulation in patients with atrial fibrillation. Chest, 1999, 115(1): 140-143.
17. Bates SM, Ginsberg JS. Treatment of deep-veinthrombosis. N Engl J Med, 2004, 35(1): 268-277.
18. Hyers TM, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease. Chest, 2001, 119(Suppl): 176S-193S.
19. 王兆鉞. 血栓與止血研究的的現狀與發展趨勢——第二十屆國際血栓與止血大會內容介紹與分析. 中華血液學雜志, 2006, 27(3): 215-216.

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Clinical analysis on the combination of low molecular weight heparin and warfarin for acute pulmonary thromboembolism after thoracotomy

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