Acute high-risk pulmonary embolism following spine surgery successfully treated by pharmaco-mechanical intervention

Abstract

Acute high-risk pulmonary embolism (PE) is defined as PE with either cardiac arrest, obstructive shock, or persistent hypotension at presentation. The incidence of venous thromboembolism (VTE) is lower following spine surgery compared to joint arthroplasty surgeries. The use of anticoagulants after spine surgery for the prevention of VTE is associated with a definite risk of epidural hematoma resulting in neurologic sequelae. Here, we report a case of a 57-year-old female who presented with cardio-respiratory arrest following spine surgery due to acute high-risk PE. In view of recent spine surgery and traumatic cardiopulmonary resuscitation, which are considered as contraindications for systemic thrombolysis and unavailability of cardiac surgery unit, the patient was treated with pharmaco-mechanical intervention resulting in successful recovery with no development of epidural hematoma or neurologic sequelae. Prophylactic anticoagulation for the prevention of VTE and the risk of epidural hematoma should be balanced after a case of spine surgery.

Keywords

• catheter-directed treatment
• pulmonary embolism
• spine surgery
• thrombolysis