Skip to main content
SpringerLink
Log in

Pulmonary embolism after brain hemorrhage in a hypertensive patient: the therapeutic dilemma

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Massive pulmonary embolism is a life-threatening condition to be treated with anticoagulants or even thrombolytic agents in selected cases. However, these drugs are controindicated after a recent hemorrhagic episode. We report the case of a 46-year-old patient with uncontrolled systemic hypertension who was affected by severe spontaneous cerebral hemorrhage and left hemiparesis. After some days of rehabilitation care he developed sudden dyspnea, tachycardia and hypotension secondary to bilateral pulmonary embolism. Owing to controindication to the use of thrombolytic agents, anticoagulant therapy with high-dose intravenous unfractionated heparin followed by oral warfarin was begun, with a successful and uncomplicated outcome. The therapeutic approach to similar not uncommon cases is debated and some hypotheses are made about the aetiology of pulmonary embolism in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Guidelines on diagnosis and management of acute pulmonary embolism (2000) Eur Heart J 21:1301–1336

    Google Scholar 

  2. Kamphuisen PW, Agnelli G, Sebastianelli M (2005) Prevention of venous thromboembolism after acute ischemic stroke. J Thromb Haemost 3:1187–1194

    Article  PubMed  CAS  Google Scholar 

  3. Merli GJ (2004) Pulmonary embolism in medical patients: improved diagnosis and the role of low-molecular-weight heparin in prevention and treatment. J Thromb Thrombol 18:117–125

    Article  Google Scholar 

  4. Hull RD, Raskob GE, Brant RF et al (2000) Low-molecular-weight heparin vs heparin in the treatment of patients with pulmonary embolism. American-Canadian Thrombosis Study Group. Arch Intern Med 160:229–236

    Article  PubMed  CAS  Google Scholar 

  5. Goldhaber SZ (1998) Pulmonary embolism. New Engl J Med 339:93–104

    Article  PubMed  CAS  Google Scholar 

  6. Gallus AS (2000) Preventing venous thromboembolism in general medical inpatients and after an ischemic stroke. Haemostasis 30(Suppl 2):64–71

    Article  PubMed  CAS  Google Scholar 

  7. Bath PM, Iddenden R, Bath FJ (2000) Low-molecular-weight heparins and heparinoids in acute ischemic stroke: a meta-analysis of randomized controlled trials. Stroke 31:1770–1778

    PubMed  CAS  Google Scholar 

  8. Adams HP Jr (2002) Emergent use of anticoagulation for treatment of patients with ischemic stroke. Stroke 33:856–861

    Article  PubMed  CAS  Google Scholar 

  9. Moonis M, Fisher M (2002) Considering the role of heparin and low-molecular-weight heparins in acute ischemic stroke. Stroke 33:1927–1933

    Article  PubMed  CAS  Google Scholar 

  10. Berge E, Sandercock P (2002) Anticoagulants versus antiplatelet agents for acute ischaemic stroke. Cochrane Database Syst Rev (4):CD003242

  11. Ischaemic stroke: acute–phase drug therapy (2005) Mostly aspirin and heparin. Prescrire Int 14:146–152

    Google Scholar 

  12. Paciaroni M, Agnelli G, Micheli S, Caso V (2007) Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials. Stroke 38:423–430

    Article  PubMed  CAS  Google Scholar 

  13. Kamphuisen PW, Agnelli G (2007) What is the optimal pharmacological prophylaxis for the prevention of deep-vein thrombosis and pulmonary embolism in patients with acute ischemic stroke? Thromb Res 119:265–274

    Article  PubMed  CAS  Google Scholar 

  14. Sacco RL, Adams R, Albers G et al (2006) Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on stroke: co-sponsored by the Council on Cardiovascular Radiology and intervention: the American Academy of Neurology affirms the value of this guideline. Circulation 113:e409–e449

    PubMed  Google Scholar 

  15. McNaughton H, Barber PA, Gommans J, Nowitz M (2005) Management problems of spontaneous ICH. Hosp Med 66:229–234

    PubMed  Google Scholar 

  16. Cohen DL (1998) Treating thrombotic complications in patients with primary intracerebral hemorrhage. J R Coll Physicians Lond 32:417–419

    PubMed  CAS  Google Scholar 

  17. Maramattom BV, Weigand S, Reinalda M, Wijdicks EF, Manno EM (2006) Pulmonary complications after intracerebral hemorrhage. Neurocrit Care 5:115–119

    Article  PubMed  Google Scholar 

  18. Bertram M, Bonsanto M, Hacke W, Schwab S (2000) Managing the therapeutic dilemma: patients with spontaneous intracerebral hemorrhage and urgent need for anticoagulation. J Neurol 247:209–214

    Article  PubMed  CAS  Google Scholar 

  19. Eckman MH, Rosand J, Knudsen KA, Singer DE, Greenberg SM (2003) Can patients be anticoagulated after intracerebral hemorrhage? A decision analysis. Stroke 34:1710–1716

    Article  PubMed  Google Scholar 

  20. Tatebayashi T, Kanno M, Tezuka M, Nitta S (2002) Recurrent pulmonary embolism with prolonged right heart failure and hypoxia after cerebral bleeding; report of a case. Kyobu Geka 55:581–584

    PubMed  CAS  Google Scholar 

  21. Fukuda I, Fukui K, Minakawa M, Koyama M, Ichinoseki I, Suzuki Y (2006) Rescue surgical embolectomy for fatal pulmonary embolism in patient with intracranial hemorrhage. Ann Thorac Surg 81:735–737

    Article  PubMed  Google Scholar 

  22. Barton AL, Dudley NJ (2002) Caval filter placement for pulmonary embolism in a patient with a deep vein thrombosis and primary intracerebral haemorrhage. Age Ageing 31:144–146

    Article  PubMed  Google Scholar 

  23. Stratmann G, Gregory GA (2003) Neurogenic and humoral vasoconstriction in acute pulmonary thromboembolism. Anesth Analg 97:341–354

    Article  PubMed  Google Scholar 

  24. Yun AJ, Lee PY, Bazar KA (2005) Can thromboembolism be the result, rather than the inciting cause, of acute vascular events such as stroke, pulmonary embolism, mesenteric ischemia, and venous thrombosis?: a maladaptation of the prehistoric trauma response. Med Hypotheses 64:706–716

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Unit, Ospedale “S.Orsola” Fatebenefratelli, via V. Emanuele II, 27, 25122, Brescia, Italy

    Carlo Oneglia & Anna Gualeni

  2. via Acquafredda 41, Gussago (Brescia) , 25064, Italy

    Carlo Oneglia

Authors
  1. Carlo Oneglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Gualeni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlo Oneglia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oneglia, C., Gualeni, A. Pulmonary embolism after brain hemorrhage in a hypertensive patient: the therapeutic dilemma. J Thromb Thrombolysis 25, 231–234 (2008). https://doi.org/10.1007/s11239-007-0053-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-007-0053-5

Keywords

Search

Navigation