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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14.	李建华, 沈学东. 华法林治疗左心房血栓的疗效. 新药与临床, 1995, 14(5): 300-301.
15.	张学义, 张薇, 黎莉, 等. 华法林溶解左心耳血栓机制的研究. 中国老年学杂志, 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.
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18.	Hyers TM, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease. Chest, 2001, 119(Suppl): 176S-193S.
19.	王兆钺. 血栓与止血研究的的现状与发展趋势——第二十届国际血栓与止血大会内容介绍与分析. 中华血液学杂志, 2006, 27(3): 215-216.

1. 柳志红, 赵彦芬. 急性肺栓塞的诊断治疗现状. 中国循环杂志, 2002, 17(3): 169-170.
2. 刘心甜, 刘成伟, 吴明祥, 等. 肺栓塞溶栓与抗凝治疗的疗效及出血风险对比研究. 中国心血管杂志, 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. 程显声. 肺栓塞的临床表现与初步诊断. 中华心血管病杂志, 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 Española de Cardiología (English Edition), 2015, 68 (1): 64.
10. 林梓卿, 吴同果, 郭晓碧, 等. 低分子肝素治疗急性肺栓塞疗效分析. 实用医学杂志, 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. 殷亚昕, 夏云峰, 刘润梅, 等. 不同治疗方法对老年肺血栓栓塞症预后的影响. 中华老年心脑血管病杂志, 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. 李建华, 沈学东. 华法林治疗左心房血栓的疗效. 新药与临床, 1995, 14(5): 300-301.
15. 张学义, 张薇, 黎莉, 等. 华法林溶解左心耳血栓机制的研究. 中国老年学杂志, 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. 王兆钺. 血栓与止血研究的的现状与发展趋势——第二十届国际血栓与止血大会内容介绍与分析. 中华血液学杂志, 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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