Document Detail

Massive acute pulmonary embolism in protein S deficiency--a case report.
MedLine Citation:
PMID:  7944258     Owner:  NLM     Status:  MEDLINE    
A young man with a history of deep vein thrombosis and pulmonary embolism 11 years ago presented again with acute pulmonary embolism and was treated initially with intravenous heparin at our institution. Five days later he had another massive bout of pulmonary embolism causing hypotension. Pulmonary angiography confirmed the presence of thrombi in both pulmonary arteries, with complete obstruction of the left pulmonary artery. He was treated successfully by emergency pulmonary embolectomy. Blood investigations later confirmed the diagnosis of protein S deficiency and he was started on warfarin therapy for life. Massive pulmonary embolism should be treated aggressively. Thrombolytic therapy accelerates clot lysis, reduces pulmonary pressures, restores pulmonary capillary volume and reverses right heart failure faster than heparin alone. There is also a trend towards decreased mortality with thrombolysis. In the presence of shock, the patient should be resuscitated and if facilities for emergency embolectomy are available, surgery is a viable alternative to thrombolysis, especially if the clot burden is massive. In young patients with recurrent venous thromboembolism in the absence of obvious predisposing factors, it is important to exclude inherited plasma protein deficiencies of protein S, protein C, antithrombin III, plasminogen and fibrinogen.
R M Kam; A T Tan; T S Chee; J Wong
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Annals of the Academy of Medicine, Singapore     Volume:  23     ISSN:  0304-4602     ISO Abbreviation:  Ann. Acad. Med. Singap.     Publication Date:  1994 May 
Date Detail:
Created Date:  1994-11-10     Completed Date:  1994-11-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7503289     Medline TA:  Ann Acad Med Singapore     Country:  SINGAPORE    
Other Details:
Languages:  eng     Pagination:  396-9     Citation Subset:  IM    
Department of Cardiology, Singapore General Hospital.
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MeSH Terms
Acute Disease
Protein S Deficiency / complications*,  diagnosis
Pulmonary Embolism / etiology*
Thrombophlebitis / etiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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