How to manage anticoagulation in a case of pulmonary embolism in a patient with a haemorrhagic stroke ?

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Ian Ewart

PE following stroke(haemorrhagic or otherwise) is not uncommon but simultaneous presentation is much less so.

The treatment options are generally very limited although some may advise that NOACs present less risk than agents such as warfarin.

This might be of some use...

Management of pulmonary embolism after recent intracranial hemorrhage

A case report

Lee, Wei-Chieh MDa,b,*; Fang, Hsiu-Yu MDaEditor(s): NA.,Author Information

Medicine: April 2018 - Volume 97 - Issue 15 - p e0479doi: 10.1097/MD.0000000000010479

Ciprian Ilie Rosca

NOACs ant anti vitamine K is not an option. Low dose of enoxaparine or another LMHW can be used

Rajkumar Rajendram

This is a very challenging situation.

Can use sequential pneumatic compression for lower limbs. Also need to consider placement of an IVC filter if the patient has lower limb deep vein thrombosis.

Thereafter would discuss management of anticoagulation with a haematologist. Would then explain to the patient and their family the options for treatment and the potential risks and benefits.

Zerrin Pulathan

The use of anticoagulants is contrendicated in a patient with hemorrhagic stroke. A vena cava filter is indicated if there is proven proximal DVT with pulmonary embolism.