Usefulness of Oral Xa Inhibitor for Management of Ischemic Stroke Associated with Thrombosis in the Pulmonary Vein Stump after Lung Resection

Amemiya, Takeo; Shono, Toshiyuki; Yamagami, Keitaro; Takagishi, Soh; Toma, Hiroki; Kobarai, Tomonari; Eguchi, Toru; Hirota, Ichio

doi:10.1016/j.jstrokecerebrovasdis.2019.104321

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…Successful treatment with both oral vitamin K antagonists and heparin (unfractionated and low molecular weight) has been reported [ 1 ]. To our knowledge, four cases of PVT post lung resection have been reportedly treated with rivaroxaban therapy [ 8 , 9 ]. Three of these patients had brain infarcts as a complication of PVT and saw successful resolution of the thrombus within 1 month [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, four cases of PVT post lung resection have been reportedly treated with rivaroxaban therapy [ 8 , 9 ]. Three of these patients had brain infarcts as a complication of PVT and saw successful resolution of the thrombus within 1 month [ 9 ]. However, a 68-year-old man developed an idiopathic right upper PVT with extension into the left atrium while on rivaroxaban 20 mg daily for known atrial fibrillation [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary Vein Thrombosis in a Patient With Multiple Myeloma on Treatment With Lenalidomide

et al. 2021

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Multiple myeloma (MM) poses inherent risk of thrombosis that can be amplified by the use of immunomodulator therapy. We present a patient with MM who was being treated with lenalidomide and dexamethasone when he developed progressive dyspnea on exertion consistent with a left lower pulmonary vein thrombosis (PVT) despite use of prophylactic aspirin. The PVT was not initially seen on standard computed tomography angiogram pulmonary embolism protocol but was seen on 192-slice multidetector computed tomography angiogram for assessment of coronary calcifications 8 months later. Subsequent treatment with full dose rivaroxaban resulted in full clot resolution and symptom improvement. PVT has not been previously reported with lenalidomide therapy and may not be a forefront differential diagnosis. In such cases, a multi-modality diagnostic approach may be beneficial. Consideration should be given to escalating venous thromboembolism prophylaxis to full dose anticoagulation during increased prothrombotic windows, such as the time of treatment initiation or dose adjustments, in low bleeding risk patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pulmonary Vein Thrombosis in a Patient With Multiple Myeloma on Treatment With Lenalidomide

et al. 2021

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“…Importantly, all patients with a thrombus had undergone left upper lobectomy, and these comprised 13.5% of all patients that underwent left upper lobectomy [1]. A PV stump thrombus other than that of the left superior PV is very rare, and there are only a few reports [8,9]. The higher frequency of thrombus formation in the left superior PV stump could be because LUL leaves a longer PV stump than other types of lobectomy, which may lead to stagnant blood flow in the PV stump [1].…”

Section: Discussionmentioning

confidence: 99%

Acute limb ischemia by a pulmonary vein stump thrombus after left lower lobectomy: a case report

et al. 2021

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Background Cases of systemic thromboembolism due to thrombus formation in the pulmonary vein stump after lobectomy have been reported recently. Cerebral infarction after left upper lobectomy is a common symptom in these cases. We encountered a rare case of acute limb ischemia caused by a thrombus formed in the left inferior pulmonary vein stump after left lower lobectomy. Case presentation A 62-year-old man underwent video-assisted left lower lobectomy under general anesthesia with epidural anesthesia. On postoperative day 2, he suddenly developed pain in the left calf. Contrast-enhanced computed tomography showed left popliteal artery occlusion and thrombus formation in the left inferior pulmonary vein stump. Anticoagulant therapy was started immediately, and emergent endovascular thrombectomy was performed. The patient recovered without complications. Conclusions Left lower lobectomy can cause thrombus formation in the pulmonary vein stump, leading to systemic thromboembolism. Early detection and treatment are the keys to minimize complications.

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“…Postoperative cerebral infarction is one of the more uncommon but devastating complications, which imposes a heavy burden on patients and families. It has been reported that the incidence of postoperative cerebral infarction is 0.6-1.1% in patients after thoracic surgery (1). Several previous studies have suggested that old age, male sex, comorbidity, and left upper lobectomy are associated with postoperative cerebral infarction (2,3).…”

Section: Introductionmentioning

confidence: 98%

Risk factors for postoperative cerebral infarction in patients after lung resection: a single-center case-control study

Gao¹,

Zhou²,

Yang³

et al. 2023

J Thorac Dis

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Background: Patients who undergo lung resection are at risk of postoperative cerebral infarction, but the risk factors remain unclear, so the present study was a comprehensive investigation in patients who underwent lung resection for pulmonary nodules. Methods:The clinical characteristics of patients with postoperative cerebral infarction and patients who underwent lung resection on the same day but did not develop cerebral infarction were retrospectively compared. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for cerebral infarction after lung resection.Results: A total of 22 patients with postoperative cerebral infarction and 316 controls were included.Multivariate logistic regression analysis revealed that a history of cerebral infarction (odds ratio [OR], 7.289; P=0.030), activated partial thromboplastin time (APTT) <26.5 s (OR, 3.704; P=0.018), body mass index (BMI) ≥24.0 kg/m 2 (OR, 3.656; P=0.015), and surgical method (P=0.005) were independent risk factors for cerebral infarction after lung resection. Compared with patients undergoing lobectomy, the risk for postoperative cerebral infarction was significantly increased in patients undergoing segmentectomy (OR, 24.322; P=0.001), wedge resection (OR, 6.992; P=0.018), or combined surgical approach (OR, 29.921; P=0.028).Conclusions: A history of cerebral infarction, APTT <26.5 s, BMI ≥24.0 kg/m 2 , and surgical method were independent risk factors for cerebral infarction after lung resection. Strengthening thromboprophylaxis in patients with these risk factors may help to reduce the incidence of postoperative cerebral infarction.

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Usefulness of Oral Xa Inhibitor for Management of Ischemic Stroke Associated with Thrombosis in the Pulmonary Vein Stump after Lung Resection

Cited by 9 publications

References 9 publications

Pulmonary Vein Thrombosis in a Patient With Multiple Myeloma on Treatment With Lenalidomide

Pulmonary Vein Thrombosis in a Patient With Multiple Myeloma on Treatment With Lenalidomide

Acute limb ischemia by a pulmonary vein stump thrombus after left lower lobectomy: a case report

Risk factors for postoperative cerebral infarction in patients after lung resection: a single-center case-control study

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