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PE thromobolysis in recent surgery and brain tumors ...ACCP updates

What is the risk of thrombolysis in a patient with recent surgery, previous stroke or intracranial space-occupying lesion? 

 Thrombolysis after recent surgeryThey identified 25 reports, including 64 patients, thrombolysed (the majority for PE) following major recent surgery. Major bleeding occurred in >50% of patients receiving thrombolysis within 1week of surgery and in 20% of patients thrombolysed 1–2 weeks post- operatively. American College of Chest Physicians (ACCP) guidelines suggest that recent surgery (excluding recent brain or spinal surgery or trauma) is a relative contraindication and that the bleeding risk reduces significantly 2 weeks after surgery.

Thrombolysis in the presence of intracranial space-occupying lesions?
A review of 12 patients with intracranial neoplasms thrombolysed for various indications identified ICH in a single patient (8.3%).Guillan et al identified five cases (five meningiomas, one choles- teatoma and one paranasal tumour) receiving systemic thromboly- sis for stroke without complications. The risk of ICH is dependent on tumour type and localisation. A clinicopathological study showed the risk of microscopic and macroscopic spontaneous bleeding to be 50% in metastatic melanoma and ranging from 29.2% in oligodendroglioma to 2.8% in meningioma.
  1. Wright HJ, Campbell R, Ellis S, et al. Thrombolysis for postoperative pulmonary embolism: limiting the risk of haemorrhage. Thorax 2010;66:452.
  2. Etgen T, Steinich I, Gsottschneider L. Thrombolysis for ischemic stroke in patients with brain tumors. J Stroke Cerebrovasc Dis 2013 Published Online First 11 June 2013 doi:10.1016/j.jstrokecerebrovasdis.2013.05.004
  3. Guillan M, Alonso-Canovas A, Garcia-Caldentey J, et al. Off-label intravenous thrombolysis in acute stroke. Eur J Neurol 2012;19:390–4.
  4. Kondziolka D, Bernstein M, Resch L, et al. Significance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg 1987;67:852–7. 

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