Usefulness of Oral Xa Inhibitor for Management of Ischemic Stroke Associated with Thrombosis in the Pulmonary Vein Stump after Lung Resection
Usefulness of Oral Xa Inhibitor for Management of Ischemic Stroke Associated with Thrombosis in the Pulmonary Vein Stump after Lung Resection
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DOI：
10.1016/j.jstrokecerebrovasdis.2019.104321
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发表时间：
2019-11-01
影响因子：
2.5
通讯作者：
Hirota, Ichio
中科院分区：
文献类型：
--
作者：
Amemiya, Takeo;Shono, Tadahisa;Hirota, Ichio
目的：脑梗死是胸腔镜肺切除术后的重要并发症。最近的报道描述了它与肺静脉（PV）残端血栓形成的关系。然而，这种并发症的最佳治疗方法仍然存在争议。我们描述了连续3例与PV残肢血栓形成相关的脑梗死病例，这些病例成功地使用口服Xa抑制剂利伐沙班治疗。方法与结果：回顾性分析3例患者的病历资料。第一个病例是一名72岁的男性，他接受了左上肺叶切除术治疗肺腺癌。第二个病例是一名55岁的男性，他接受右下节段切除术治疗巴雷特食管癌转移瘤。第三个病例是一位73岁的男性，他接受了左上肺叶切除术以治疗结肠腺癌转移性肿瘤。第一例患者出现大面积小脑梗死，术后第4天行减压开颅术。第2例和第3例患者在术后第2天出现大脑中动脉右侧脑梗死。在所有病例中，对比增强计算机断层扫描显示静脉残端有血栓。口服利伐沙班治疗无不良反应，静脉血栓在1个月内消失。讨论：肺切除后长PV残端血流停滞可能导致血栓形成。口服Xa抑制剂利伐沙班对于肺切除术后伴有PV血栓形成的缺血性脑卒中的治疗似乎是安全有效的。
Objectives: Brain infarction is a critical complication after lung resection using video-assisted thoracoscopic surgery. Recent reports have described its association with thrombosis in the pulmonary vein (PV) stump. However, the optimal management of this complication remains controversial. We describe serial 3 cases of brain infarctions associated with thrombosis in the PV stumps, which were successfully treated with the oral Xa inhibitor rivaroxaban. Methods and Results: We retrospectively reviewed medical records of 3 patients. The first case was a 72-year-old man who underwent left upper lobectomy for treatment of lung adenocarcinoma. The second case was a 55-year-old man who underwent right lower segmentectomy for treatment of metastatic tumor from Barrett's esophageal carcinoma. The third case was a 73-year-old man who underwent left upper lobectomy for treatment of metastatic tumor from colon adenocarcinoma. In the first case, a large cerebellar infarction was developed and a decompressive craniotomy was performed on postoperative day 4. In the second and the third case, cerebral infarctions in the territories of right middle cerebral arteries occurred on postoperative day 2. In all cases, contrast-enhanced computed tomography demonstrated the thrombi in the stumps of the PVs. They were treated with oral administration of rivaroxaban without adverse effect, and the thrombi in the PVs disappeared within 1 month. Discussion: Blood flow stasis in the long PV stump after lung resection might contribute to thrombosis development. Oral Xa inhibitor rivaroxaban appeared to be safe and useful for the management of ischemic stroke associated with PV thrombosis after lung resection.