Oneglia Carlo, Gualeni Anna
Cardiology Unit, Ospedale S.Orsola Fatebenefratelli, via V Emanuele II, 27, 25122 Brescia, Italy.
J Thromb Thrombolysis. 2008 Apr;25(2):231-4. doi: 10.1007/s11239-007-0053-5. Epub 2007 May 30.
Massive pulmonary embolism is a life-threatening condition to be treated with anticoagulants or even thrombolytic agents in selected cases. However, these drugs are controindicated after a recent hemorrhagic episode. We report the case of a 46-year-old patient with uncontrolled systemic hypertension who was affected by severe spontaneous cerebral hemorrhage and left hemiparesis. After some days of rehabilitation care he developed sudden dyspnea, tachycardia and hypotension secondary to bilateral pulmonary embolism. Owing to controindication to the use of thrombolytic agents, anticoagulant therapy with high-dose intravenous unfractionated heparin followed by oral warfarin was begun, with a successful and uncomplicated outcome. The therapeutic approach to similar not uncommon cases is debated and some hypotheses are made about the aetiology of pulmonary embolism in these patients.
大面积肺栓塞是一种危及生命的疾病，在某些情况下需使用抗凝剂甚至溶栓剂进行治疗。然而，近期有出血发作后，这些药物是禁忌的。我们报告了一例46岁的患者，患有无法控制的系统性高血压，并发严重自发性脑出血和左侧偏瘫。经过几天的康复护理后，他因双侧肺栓塞继发突然出现呼吸困难、心动过速和低血压。由于禁忌使用溶栓剂，开始采用大剂量静脉注射普通肝素随后口服华法林的抗凝治疗，结果成功且未出现并发症。对于类似的并不罕见的病例，其治疗方法存在争议，并且对这些患者肺栓塞的病因提出了一些假设。
