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Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review.

Abstract：

BACKGROUND:The requirement of postoperative bedridden and immobilization renders neurosurgical patients with higher risk of deep vein thrombosis (DVT), then more vulnerable for pulmonary thromboembolism (PTE). But silent pulmonary thromboembolism (SPTE) can be the very early stage of any typical form of PTE, its diagnosis and management is therefore critical in neurosurgical departments. However, to date, perioperative SPTE has not been attached with enough attention. METHODS:Here, we report 2 cases of perioperative SPTE in the Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China. Clinical data of 2 cases was collected and analyzed. Both patients were screened by quantitative D-dimer assay and lower limbs ultrasonography, while diagnoses were made according to computed tomographic pulmonary angiography (CTPA). Therapeutic medications include heparin, low molecular weight heparin, followed by long-term anticoagulation with oral warfarin. Both cases showed significantly elevated D-dimer before and after onset of SPTE. But in 1 case, ultrasonography reported negative venous thromboembolism. CTPA confirmed all diagnosis of SPTE. Repeated CTPA after anticoagulant therapy identified therapeutic efficacy. And during the follow-up period of 5 or 6 years, both patients acquired full recovery without clinical complications. RESULTS:Significant decline of D-dimer was observed after the comprehensive management of SPTE (case 1: preop vs postop 573 vs 50 μg/L; case 2: preop vs postop 246 vs 50 μg/L). Ultrasonography was used for suspicious of DVT, while CTPA was used for confirming SPTE diagnosis. CONCLUSION:Clinicians should be aware of the importance of early recognition of SPTE. Effective management of risk factors of hyper-coagulation state should be the key to prophylaxis. And routine monitor of D-dimer as well as regular check of lower limbs ultrasonography should be standardized and included in guidelines of neurosurgical patient management.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Tian R,Gao J,Chen A,Bao X,Guan J,Feng M,Li Y,Ma W,Ren Z,Wang R,Wei J

doi

10.1097/MD.0000000000004589

subject

Has Abstract

pub_date

2016-08-01 00:00:00

pages

e4589

issue

eissn

0025-7974

issn

1536-5964

pii

00005792-201608160-00042

journal_volume

pub_type

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Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review.