Limb-Threatening Acute Venous Thromboembolism in a Patient Undergoing Postarrest Therapeutic Hypothermia

Ther Hypothermia Temp Manag. 2015 Dec;5(4):228-34. doi: 10.1089/ther.2015.0019. Epub 2015 Nov 17.

Abstract

Postcardiac arrest patients are at high risk for developing venous thromboembolism (VTE). Current postarrest guidelines do not provide recommendations for prevention or surveillance of VTE and there is little guidance regarding the optimal prophylaxis or treatment of VTE during therapeutic hypothermia (TH). Many patients develop acute liver dysfunction resulting from severe global hypoperfusion during cardiac arrest, compounding concerns for bleeding with the initiation of TH. However, significant VTE may occur following arrest and can contribute to additional morbidity and mortality. The pharmacokinetics of anticoagulation, the routine treatment for VTE, have not been extensively researched or tested under hypothermic conditions. Standard approaches for prevention and treatment have been utilized, such as unfractionated heparin, but their efficacy remains uncertain. This case illustrates the significant imbalance of coagulation in a postcardiac arrest patient undergoing TH.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Aged
  • Angioplasty
  • Anticoagulants / therapeutic use
  • Blood Coagulation
  • Fatal Outcome
  • Female
  • Heart Arrest / complications
  • Heart Arrest / diagnosis
  • Heart Arrest / physiopathology
  • Heart Arrest / therapy*
  • Humans
  • Hypothermia, Induced* / adverse effects
  • Thrombectomy
  • Treatment Outcome
  • Venous Thromboembolism / diagnosis
  • Venous Thromboembolism / etiology*
  • Venous Thromboembolism / therapy

Substances

  • Anticoagulants