Skip to main content Accessibility help
×
Home

An Important Dilemma: Fibrinolytic Treatment in Bleeding Diathesis

Published online by Cambridge University Press:  07 October 2020

Mustafa Emin Canakci
Affiliation:
Emergency Department, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
Volkan Ercan
Affiliation:
Intensive Care Unit, Eskisehir City Hospital, Eskisehir, Turkey
Nurdan Acar
Affiliation:
Emergency Department, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
Serdar Efe
Affiliation:
Intensive Care Unit, Eskisehir City Hospital, Eskisehir, Turkey
Corresponding
E-mail address:

Abstract

Pulmonary embolism is a clinical condition with high mortality rates in all age groups. The treatment includes anticoagulation and fibrinolytic therapy, and clinical management is challenging in cases of bleeding diathesis. Sepsis-induced coagulopathy (SIC), which has been recently defined to cause disruption of coagulation cascade accompanied by organ dysfunctions, is regarded as a major cause of mortality. It is noteworthy that there is no decrease in fibrinogen levels, unlike disseminated intravascular coagulopathy (DIC). This study aimed to present the management of a 70-year-old female patient who was admitted to emergency department with atypical complaints and diagnosed with pulmonary embolism due to deep vein thrombosis and septic shock. The clinical success of fibrinolytic therapy following the administration of fresh frozen plasma (FFP), although the patient had elevated international normalized ratio (INR), is presented in this case report. Since elevated INR and thrombocytopenia, which are observed in SIC, are caused by the inhibition of fibrinolysis, fibrinolytic therapy can be a rational treatment choice considering the profit/loss rate.

Type
Case Report
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below.

References

Alotaibi, GS, Wu, C, Senthilselvan, A, McMurtry, MS. Secular trends in incidence and mortality of acute venous thromboembolism: the AB-VTE population-based study. Am J Med. 2016;129(8):879 Google ScholarPubMed
Stein, PD, Beemath, A, Matta, F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med. 2007;120(10):871879.CrossRefGoogle ScholarPubMed
Konstantinides, SV, Meyer, G, Becattini, C, 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):543603.Google Scholar
Taylor, FB, Toh, CH, Hoots, WK, Wada, H, Levi, M; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86(5):13271330.CrossRefGoogle Scholar
Iba, T, Nisio, MD, Levy, JH, Kitamura, N, Thachil, J. New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: a retrospective analysis of a nationwide survey. BMJ Open. 2017;7(9):e017046.CrossRefGoogle ScholarPubMed
Lyons, PG, Micek, ST, Hampton, N, Kollef, MH. Sepsis-associated coagulopathy severity predicts hospital mortality. Crit Care Med. 2018;46(5):736742.CrossRefGoogle ScholarPubMed
Iba, T, Levi, M, Levy, JH. Sepsis-induced coagulopathy and disseminated intravascular coagulation. Semin Thromb Hemost. 2020;46(1):8995.Google ScholarPubMed
Iba, T, Levy, JH. Sepsis-induced coagulopathy and disseminated intravascular coagulation. Anesthesiology. 2020;132(5):12381245.CrossRefGoogle ScholarPubMed
Rangel-Frausto, MS, Pittet, D, Costigan, M, Hwang, T, Davis, CS, Wenzel, RP. The natural history of the Systemic Inflammatory Response Syndrome (SIRS): a prospective study. JAMA. 1995;273(2):117123.Google ScholarPubMed
Aujesky, D, Obrosky, DS, Stone, RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172(8):10411046.CrossRefGoogle ScholarPubMed
Fengler, BT, Brady, WJ. Fibrinolytic therapy in pulmonary embolism: an evidence-based treatment algorithm. Am J Emerg Med. 2009;27(1):8495.Google Scholar
Wojciechowski, VV, Calina, D, Tsarouhas, K, et al. A guide to acquired vitamin K coagulopathy diagnosis and treatment: the Russian perspective. DARU J Pharm Sci. 2017;25(1):10.CrossRefGoogle ScholarPubMed
Gando, S, Iba, T, Eguchi, Y, et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med. 2006;34(3):625631.CrossRefGoogle ScholarPubMed
Iba, T, Umemura, Y, Watanabe, E, Wada, T, Hayashida, K, Kushimoto, S. Diagnosis of sepsis-induced disseminated intravascular coagulation and coagulopathy. Acute Med Surg. 2019;6(3):223232.Google ScholarPubMed
Iba, T, Levy, JH. Derangement of the endothelial glycocalyx in sepsis. J Thrombos Haemostas. 2019;17(2):283294.CrossRefGoogle ScholarPubMed

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 16
Total number of PDF views: 28 *
View data table for this chart

* Views captured on Cambridge Core between 07th October 2020 - 17th January 2021. This data will be updated every 24 hours.

Hostname: page-component-77fc7d77f9-n279q Total loading time: 0.259 Render date: 2021-01-17T16:59:26.491Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags last update: Sun Jan 17 2021 16:54:32 GMT+0000 (Coordinated Universal Time) Feature Flags: { "metrics": true, "metricsAbstractViews": false, "peerReview": true, "crossMark": true, "comments": true, "relatedCommentaries": true, "subject": true, "clr": true, "languageSwitch": true, "figures": false, "newCiteModal": false, "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true }

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

An Important Dilemma: Fibrinolytic Treatment in Bleeding Diathesis
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

An Important Dilemma: Fibrinolytic Treatment in Bleeding Diathesis
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

An Important Dilemma: Fibrinolytic Treatment in Bleeding Diathesis
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *