THROMBOLYSIS FOR LIFE-THREATENING PULMONARY-EMBOLISM 2 DAYS AFTER LUNG RESECTION

Early postoperative severe pulmonary embolism is usually considered an indication for surgical embolectomy because thrombolytic agents canno t be used. Severe pulmonary embolism was diagnosed 2 days after lung r esection in two patients, including one with hypercapnia during sponta neous breathing, perhaps a unique feature of massive embolism on a sin gle lung. Although emergency surgical embolectomy was available, both patients were given a bolus infusion of thrombolytic agents, with an i mmediate (within 1 h) clinical and hemodynamic improvement and a favor able outcome despite delayed major bleeding in one patient. The report ed data and an analysis of the available literature support the view t hat recent surgery should be considered a relative rather than absolut e contraindication to thrombolysis and that decision making in this se tting should be based on a careful case-by-case evaluation of the expe cted benefits and risks of the various available treatments.