Successful thrombolysis in postoperative patients with acute massive pulmonary embolism

Purpose: The standard medical management for patients with acute massive pulmonary embolism (MPE) is systemic thrombolysis. However, it is generally thought that recent surgeries are a contraindication to thrombolytic therapy. In this study, we evaluated the efficacy and safety of systemic thrombolysis for postoperative patients with acute MPE and assessed the risk of bleeding. Methods: A retrospective review was performed on 21 postoperative patients with MPE in a timeframe of five years (from 2005 to 2010). The criteria for study inclusion were postoperative patients who received systemic thrombolysis for confirmed acute MPE within three weeks after surgery. Results: Seventeen postoperative patients, including men (12) and women (five) aged 53 ± 16 (range 23-71) years, were treated with systemic thrombolysis. Significant haemodynamic improvement (shock index < 0.9) was observed in 16 of 17 cases (94%). The remaining patient (6%) died of cardiac arrest within 24. h. No major bleeding complication was observed. Sixteen patients survived and remained stable for 34 ± 16 (range 11-52) days until hospital discharge. Conclusion: Recent surgery is not an absolute contraindication to systemic thrombolysis. Further, to obtain a successful outcome, it is crucial to exclude patients who have received neurosurgical operations or those with other contraindications to thrombolytic therapy.