Systemic thrombolysis in postoperative neurosurgical patients with massive pulmonary embolism (case series and review)

Neurosurgical patients represent a high-risk group for pulmonary embolism (PE). Patients with PE and high risk of death require immediate reperfusion therapy—mechanical reperfusion or systemic thrombolysis. Thrombolytic therapy (TLT) provides rapid reduction of obstruction and decreases pulmonary artery pressure, but it is associated with high risk of hemorrhagic complications. An absolute contraindication for TLT is central nervous system disease. When choosing a treatment strategy, one should consider PE-related risk of death with likelihood and consequences of intracranial hemorrhage. This article describes TLT in neurosurgical patients with massive PE and high risk of death over a 4.5-year follow-up period.