Early thrombolysis in an elderly patient: case report
© Delle Curti et al; licensee BioMed Central Ltd. 2011
Published: 24 August 2011
Pulmonary thromboembolism (TEP) is related to the migration of thrombotic material from the systemic venous circulation to pulmonary vascular tree, with obstruction of the pulmonary arterial circulation.
The mortality rate is 30% in non-identifiable forms, and 2-8% in those treated earlier.
The early use of thrombolytics determines the success of the lysis. Thrombolysis is considered a proven treatment in the management of acute, massive forms of TEP that accompany a hemodynamic instability, but differences arise over time, the doses and which thrombolytic use, to minimize the adverse events in compromised patients. Adverse events are: major bleeding, strokes, severe hypotension, allergies, re-thrombosis and reperfusion syndrome.
Contraindications are: absolute (internal bleeding in progress, recent spontaneous intracranial hemorrhage) and relative (interventions Chir. <10 days, stroke <2m., Gastric bleeding <10 days, Major trauma <15 days, Recent CPR, PTL <100,000, poorly controlled severe hypertension, pregnancy).
Vincenzo R. 71 years-old, Kg110, is hospitalized for endoscopic pneumatic lithotripsy for an upper right ureter calculosis.
U.S. the lower limbs: thrombosis of the twin vein medial.
The case report is characterized by the presence of the most frequent risk factors for TEP, DVT, obesity, and by clear indications for thrombolysis: severe hemodynamic instability, the absence of contraindication, early diagnosis and therapy (<8h). This allowed the procedure to obtain a good recovery accelerated thrombolysis and clinical scintigraphy without major bleeding complications.
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