Systemic thrombolysis for prosthetic valve thrombosis in the immediate postoperative period of major abdominal surgery

BackgroundPhysicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent.MethodsFourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested.ResultsManagement dilemmas discussed include: sub-massive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants.ConclusionThe suggested approaches are based on a review of the available evidence and guidelines and on our clinical experience. Management in an individual patient requires clinical assessment of risks and benefits and also depends on local availability of therapeutic interventions.

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Management dilemmas in acute pulmonary embolism

Condliffe

Elliot

Hughes

et al. 2013

Thorax

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Systemic thrombolysis for prosthetic valve thrombosis in the immediate postoperative period of major abdominal surgery

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Management dilemmas in acute pulmonary embolism

Management dilemmas in acute pulmonary embolism

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