Unexpected positive effect of fresh frozen plasma on standard anticoagulation in the case of pulmonary embolism accompanied by sepsis – a case report
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Department of Cardiology and Internal Medicine, Municipal Hospital in Olsztyn, Poland
Department of Nursing, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland
Ryszard Targoński
Miejski Szpital Zespolony, ul. Niepodległości 44, 10-045 Olsztyn, Polska; phone and fax: +48 89 527 22 35, e-mail:
Submission date: 2010-12-16
Acceptance date: 2011-02-07
Online publication date: 2012-12-01
Publication date: 2023-03-12
Pol. Ann. Med. 2011;18(1):131–138
Introduction. In recent years there have been significant advances in the diagnosis and management of venous thromboembolism. This has resulted in the establishment of detailed diagnostic and therapeutic guidelines. Despite the benefits coming from their implementations, a clinical outcome of thromboembolic complications in particular patients poses a number of diagnostic difficulties. Treatment results and prognosis, despite following commonly recognized therapeutic standards, are difficult to predict. Aim. This paper aimed at presenting an atypical course of high-risk pulmonary embolism (PE) and the remote outcome of its treatment in a surgical patient with an initial low risk of thrombotic complications. Case study. The patient was a 58-year old female with a history of primary arterial hypertension who was electively operated on for euthyreotic polynodular goiter. On the 2nd postoperative day, she had to be resuscitated due to PE accompanied by sepsis with disseminated intravascular coagulation and shock. As shock symptoms did not subside despite the administration of typical treatment (Dextran, intravenous infusion fluids, dopamine, heparin, broad-spectrum antibiotics), and because of gastrointestinal bleeding suspicion, the patient was also administered fresh frozen plasma. Following resuscitation, lasting 2.5 hours, long-term improvement in hemodynamic parameters occurred. After respiratory therapy, lasting several hours, a gradual improvement of the patient’s general condition was observed. She regained consciousness, dyspnea subsided, and features of acute right ventricular overload gradually subsided in electrocardiogram. Results and discussion. On the one hand, the effectiveness of a combined treatment employing heparin and fresh frozen plasma could have resulted from its effect on improving tissue hypoperfusion secondary to the shock; and, on the other hand, because of the coexisting intravascular coagulation process. Fresh frozen plasma, apart from its commonly known procoagulative effect, may also enhance fibrinolytic processes. The potential influence of endogenous anticoagulants contained in plasma with respect to the course of PE has been discussed. It may have contributed to the regression of PE symptoms, despite the fact that in the acute phase the patient was on heparin only. Conclusions. Fresh frozen plasma, due to its endogenous anticoagulation activity, may positively influence the course of high-risk PE.