Safety and efficacy of thrombolytic therapy in the treatment of early pulmonary embolism after thoracic surgery

Background: The incidence and mortality rates of early pulmonary embolism (PE) after thoracic surgery are high. Thrombolytic therapy is the basic treatment of PE. The aim of this study is to explore the safety and efficacy of thrombolytic therapy for patients with early postoperative PE.

Methods: Data of forty patients excluding three patients with sudden death were analyzed. The included patients were divided into: thrombolysis + anticoagulation (group A, 21 cases) and anticoagulation (group B, 16 cases). Twenty patients had esophageal cancer and 17 had lung tumors. Bleeding, drainage volume, pulmonary infection, and perioperative mortality were compared between the groups. Factors related to perioperative mortality were analyzed by multivariate logistic regression.

Results: The mortality rates of group A (19.0%) and B (81.3%) differed significantly. No massive hemorrhage or significant drainage volume differences were observed. Group A's D-dimer (D-D) level decreased, group B's D-D level increased, and was significantly different between after surgery and on the fourth day of treatment. Group B's partial oxygen pressure was significantly different between the third and fourth day of treatment, it gradually increased in group A, and remained unaltered in group B. Multivariate logistic regression supported a significant survival rate improvement.

Conclusions: Thrombolytic therapy is safe and effective for PE early after thoracic surgery in the absence of absolute contraindications for anticoagulation and thrombolysis, and it can reduce mortality in patients.