Shin Ishimaru

A case of pulmonary embolism treated with tissue plasminogen activator

A 47-year-old female manifesting deep vein thrombosis of the left leg had severe pulmonary embolism after thrombolytic therapy with t-PA for 5 days. Dyspnea was improved and PaO2 was restored from 39mmHg to 64mmHg soon after additional dosages of t-PA. Right ventricular pressure decreased from 71mmHg to 34mmHg after 1 month. Although t-PA level and D-dimer increased after giving 120.000u of t-PA, there were no obvious changes in fibrinogen, plasminogen, FDP nor α2-PI levels. Efficacy of thrombolytic therapy wtih t-PA was demonstrated by digital subtraction pulmonary angiograms taken before and after treatment.

Investigations on the anticoagulation therapy after cardiac valve replacement surgery

Features of blood coagulation system and postoperative anticoagulation therapy with Warfarin on 22 patients in which cardiac valve replacement was performed, were investigated by compared to 18 patients from peripheral vascular disease.Coagulation factor VIII was increased in both group of valvular disease and vascular disease before operation. There was no tendency of increase in F. VIII during Warfarin therapy continued for 36 months after operation. Prothrombin time was not correlated well with Thrombotest nor Hepaplastintest during Warfarin therapy. Thrombotest was affected by protein induced by vitamin K abscence (PIVKA) increased above 6-8μg/ml. It was noteworthy that % F. VIII (AHF/RAG) was reduced after valve replacement surgery, as compared with vascular disease in which reconstructive surgery was performed. These results suggest that postoperative anticoagulation therapy with Warfarin should be controlled by combination of thrombotest and Hepaplastintest. Decrease in % F. VIII (AHF/RAG) might indicate the hypercoagulability induced by mechanical valve prosthesis implantation.