Background Patients with spontaneous intracerebral hemorrhage (ICH) have a higher risk of venous thromboembolism (VTE) and in-hospital VTE is independently associated with poor outcomes for this patient population. Methods A comprehensive literature search about patients with VTE after spontaneous ICH was conducted using databases MEDLINE and PubMed. We searched for the following terms and other related terms (in US and UK spelling) to identify relevant studies: intracerebral hemorrhage, ICH, intraparenchymal hemorrhage, IPH, venous thromboembolism, VTE, deep vein thrombosis, DVT, pulmonary embolism, and PE. The search was restricted to human subjects and limited to articles published in English. Abstracts were screened and data from potentially relevant articles was analyzed. Results The prophylaxis and treatment of VTE are of vital importance for patients with spontaneous ICH. Prophylaxis measures can be mainly categorized into mechanical prophylaxis and chemoprophylaxis. Treatment strategies include anticoagulation, vena cava filter, systemic thrombolytic therapy, catheter-based thrombus removal, and surgical embolectomy. We briefly summarized the state of knowledge regarding the prophylaxis measures and treatment strategies of VTE after spontaneous ICH in this review, especially on chemoprophylaxis and anticoagulation therapy. Early mechanical prophylaxis, especially with intermittent pneumatic compression, is recommended by recent guidelines for patients with spontaneous ICH. While decision-making on chemoprophylaxis and anticoagulation therapy evokes debate among clinicians, because of the concern that anticoagulants may increase the risk of recurrent ICH and hematoma expansion. Uncertainty still exists regarding optimal anticoagulants, the timing of initiation, and dosage. Conclusion Based on current evidence, we deem that initiating chemoprophylaxis with UFH/LMWH within 24–48 h of ICH onset could be safe; anticoagulation therapy should depend on individual clinical condition; the role of NOACs in this patient population could be promising.

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The purpose of this study was to define the origin of life-threatening hemoptysis in patients with pulmonary embolism and a preliminary evaluation of the use of ethylene vinyl alcohol copolymer in pulmonary embolism patients with fatal massive hemoptysis. MATERIALS AND METHODS. Three patients (2 men, 1 women; age range, 49-76 years; mean, 66 years) with pulmonary embolism and life-threatening hemoptysis who were underwent bronchial artery embolization with ethylene vinyl alcohol copolymer. We specifically assessed and compared the indications, immediate control of hemoptysis, and clinical tolerability. RESULTS. All three patients all diagnosed with pulmonary embolism with computed tomography pulmonary angiography (CTPA). Patient 1 was a 76 year old man who has a massive hemoptysis with over 500ml in a day. Patient 2 was a 49 year old man with recurrent hemoptysis for 20 years with a total volume over 500ml. Patient 3 was a 73 year old woman with recurrent hemoptysis over 500ml in over one year. Bronchial artery CT angiography revealed bronchial artery-pulmonary artery fistulas in these three patients. According to relevant studies, pulmonary embolism often cause small amount of hemoptysis, so the hemoptysis was thought caused by systemic-topulmonary artery fistula, which was the indication for embolization with ethylene vinyl alcohol copolymer. Also, absolute necessity for anticoagulation therapies for these three patients also became another indication for embolization. All three patients are treated with ethylene vinyl alcohol copolymer and hemoptysis was controlled. Patient 1 was found little blood(<10ml) in the sputum for four days after the embolization and it was thought caused by the rest blood in the airway and he didn't show a recurrent of hemoptysis after that. CONCLUSION. In patients diagnosed with pulmonary embolism, massive hemoptysis usually not caused by pulmonary embolism, bronchial artery-pulmonary artery fistula should be thought in clinical work. Ethylene vinyl alcohol copolymer embolization for the treatment of life-threatening hemoptysis of bronchial artery-pulmonary artery fistula is feasible, well tolerated and effectiveness.

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