Email this article 
Post a Comment Pulmonary artery thrombosis. Clinical cases
- Authors: Porembskaya O.Y.1, Tsaplin S.N.2, Lobastov K.V.2, Ilina V.A.1,3, Kravchuk V.N.1, Sayganov S.A.1
-
Affiliations:
- North-Western State Medical University named after I.I. Mechnikov
- Pirogov Russian National Research Medical University
- Clinical Hospital No. 1 of the Presidents Administration of Russian Federation
- Issue: Vol 15, No 4 (2023)
- Pages: 73-79
- Section: Case report
- URL: https://bakhtiniada.ru/vszgmu/article/view/257467
- DOI: https://doi.org/10.17816/mechnikov623001
- ID: 257467
Cite item
Open Access
Access granted
Subscription Access
Abstract
Accumulating evidence supports the need to consider pulmonary artery thrombosis the separate thrombotic complication, which requires its own treatment algorithms.
The aim of the work is to demonstrate the pulmonary artery thrombosis clinical aspects and the effect of the standard thrombotic prophylactic algorithms with clinical examples.
Clinical cases of patients with pulmonary artery thrombosis are presented. Pulmonary artery thrombosis is considered to be the thrombotic obstruction of the pulmonary artery branches in the absence of venous and cardiac chambers thrombosis.
Patient S. with COVID-19 and 75% of lung involvement was treated in the accordance with the actual COVID-19 treatment recommendations. Enoxaparin sodium 6000 IE once a day followed by the increasing dosage of 8000 IE twice a day was used. To prevent exacerbation tocilizumab was infused, and systemic thrombolytic therapy was performed. On the 6th day after systemic thrombolytic therapy patient died. Examination revealed thrombi in the pulmonary artery branches.
Patient P. with continued growth of cerebral left frontoparietal region glioblastoma was hospitalized. Surgical tumor removal was performed a year ago. Conservative therapy, dexamethasone injections and anticoagulant prophylaxis (enoxaparin sodium 4000 IE once a day) were prescribed. After the patient death thrombi were found in the pulmonary artery segmental branches.
Outpatient D. had a history of four episodes of dyspnea during the acute respiratory diseases. Computed tomography performed at the time of the third and fourth episodes revealed thrombi in the pulmonary artery segmental branches. The fourth episode occured despite anticoagulant prophylaxis with rivaroxaban (10 mg once a day). Patient was recommended to switch to low molecular weight heparins in case of any disease. There have been no recurrent episodes over the past 8 months.
Distinctive features of pulmonary artery thrombosis pathogenesis determine the development of the complication despite anticoagulant prophylaxis. Preventive effect of anti-inflammatory drugs on the pulmonary artery thrombosis development has not been demonstrated.
Full Text
##article.viewOnOriginalSite##About the authors
Olga Ya. Porembskaya
North-Western State Medical University named after I.I. Mechnikov
Author for correspondence.
Email: porembskaya@yandex.ru
ORCID iD: 0000-0003-3537-7409
SPIN-code: 9775-1057
MD, Cand. Sci. (Med.), Assistant Professor
Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015Sergey N. Tsaplin
Pirogov Russian National Research Medical University
Email: tsaplin-sergey@rambler.ru
ORCID iD: 0000-0003-1567-1328
SPIN-code: 8827-1385
MD, Cand. Sci. (Med.), Assistant Professor
Russian Federation, MoscowKirill V. Lobastov
Pirogov Russian National Research Medical University
Email: lobastov_kv@mail.ru
ORCID iD: 0000-0002-5358-7218
SPIN-code: 2313-0691
MD, Cand. Sci. (Med.), Assistant Professor
Russian Federation, MoscowVictoria A. Ilina
North-Western State Medical University named after I.I. Mechnikov; Clinical Hospital No. 1 of the Presidents Administration of Russian Federation
Email: profkomniisp@mail.ru
ORCID iD: 0000-0002-7658-0297
SPIN-code: 8934-1156
MD, Dr. Sci. (Med.)
Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015; Saint PetersburgViacheslav N. Kravchuk
North-Western State Medical University named after I.I. Mechnikov
Email: kravchuk9@yandex.ru
ORCID iD: 0000-0002-6337-104X
SPIN-code: 4227-2846
MD, Dr. Sci. (Med.), Professor
Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015Sergey A. Sayganov
North-Western State Medical University named after I.I. Mechnikov
Email: sergey.sayganov@szgmu.ru
ORCID iD: 0000-0001-8325-1937
SPIN-code: 2174-6400
MD, Dr. Sci. (Med.), Professor
Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015References
- Porembskaya OYa, Kravchuk VN, Lobastov KV, et al. Pulmonary artery thrombosis: strategy of anticoagulation. Pirogov Russian Journal of Surgery. 2021;(11):76–82. (In Russ.) doi: 10.17116/hirurgia202111176
- Knudson MM, Gomez D, Haas B, et al. Three thousand seven hundred thirty-eight posttraumatic pulmonary emboli: a new look at an old disease. Ann Surg. 2011;254(4):625–632. doi: 10.1097/SLA.0B013E3182300209
- Paffrath T, Wafaisade A, Lefering R, et al. Venous thromboembolism after severe trauma: incidence, risk factors and outcome. Injury. 2010;41(1):97–101. doi: 10.1016/J.INJURY.2009.06.010
- Baranga L, Khanuja S, Scott J. In situ pulmonary arterial thrombosis: Literature review and clinical significance of a distinct entity. Am J Roentgenol. 2023;221(1):57–68. doi: 10.2214/AJR.23.28996
- Ten Cate V, Prochaska JH, Schulz A, et al. Clinical profile and outcome of isolated pulmonary embolism: a systematic review and meta-analysis. EClinicalMedicine. 2023;59:101973. doi: 10.1016/j.eclinm.2023.101973
- Porembskaya O, Toropova Y, Tomson V, et al. Pulmonary artery thrombosis: A diagnosis that strives for its independence. Int J Mol Sci. 2020;21(14):5086. doi: 10.3390/ijms21145086
- Menezes RG, Rizwan T, Saad Ali S, et al. Postmortem findings in COVID-19 fatalities: A systematic review of current evidence. Leg Med (Tokyo). 2022;54:102001. doi: 10.1016/j.legalmed.2021.102001
- Porembskaya O, Lobastov K, Pashovkina O, et al. Thrombosis of pulmonary vasculature despite anticoagulation and thrombolysis: The findings from seven autopsies. Thrombosis Update. 2020;1:100017. doi: 10.1016/j.tru.2020.100017
- Jayasinghe AMK, Kirindage KGIS, Fernando IPS, et al. The anti-inflammatory effect of low molecular weight fucoidan from sargassum siliquastrum in lipopolysaccharide-stimulated RAW 264.7 macrophages via inhibiting NF-κB/MAPK signaling pathways. Mar Drugs. 2023;21(6):347. doi: 10.3390/md21060347
- Konstantinides SV, Meyer G, Bueno H, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Eur Heart J. 2020;41(4):543–603. doi: 10.1093/eurheartj/ehz405
- Seliverstov EI, Lobastov KV, Ilyukhin EA, et al. Prevention, diagnostics and treatment of deep vein thrombosis. Russian Experts consensus. Flebologiya. 2023;17(3):152–296. (In Russ.) doi: 10.17116/flebo202317031152
- Nguyen GC, Bernstein CN, Bitton A, et al. Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian association of gastroenterology. Gastroenterology. 2014;146(3):835–848.e6. doi: 10.1053/j.gastro.2014.01.042
Supplementary files
