Li Hanzhou, Jen Serena, Agarwal Shvetank, Rotem Eran
Department of Radiology, Medical College of Georgia, Augusta University, Augusta, GA, USA.
Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
Lung India. 2018 Jul-Aug;35(4):336-338. doi: 10.4103/lungindia.lungindia_383_17.
Catheter-directed thrombolysis (CDT) for the treatment of acute pulmonary embolism (PE) has gained popularity in recent years, but potential complications during the procedure and their management are not frequently discussed in the literature. In this case report, we describe the clinical dilemma regarding the postoperative anticoagulation management of a 60-year-old male who developed cardiac perforation during a CDT of an acute saddle PE. Early resumption of systemic heparin in such cases may help in clot resolution; however, it can worsen the hemopericardium. On the other hand, delaying restarting heparin may help in healing of the cardiac perforation but can lead to clot propagation. As the chest tube output was minimal initially, anticoagulation was started, which, however, led to disastrous outcome. With limited published medical literature to help guide such a complex situation, it may be prudent to carefully weigh the risks and benefits of resuming systemic heparin versus delaying it for 1-2 days to allow for definitive resolution of the cardiac perforation.
近年来，导管直接溶栓术（CDT）治疗急性肺栓塞（PE）越来越受到欢迎，但该手术过程中的潜在并发症及其处理在文献中并不常被讨论。在本病例报告中，我们描述了一名60岁男性在急性鞍状PE的CDT过程中发生心脏穿孔后，术后抗凝管理方面的临床困境。在此类病例中早期恢复全身肝素治疗可能有助于血栓溶解；然而，这可能会加重心包积血。另一方面，延迟重新使用肝素可能有助于心脏穿孔的愈合，但会导致血栓扩展。由于最初胸腔引流管引流量极少，于是开始了抗凝治疗，然而却导致了灾难性后果。鉴于可供指导这种复杂情况的已发表医学文献有限，谨慎权衡恢复全身肝素治疗与延迟1 - 2天以便心脏穿孔得到明确解决的风险和益处可能是明智的。
