PDF(Sci-hub)
Abstract：
Haemoptysis is a potentially life-threatening symptom, which require immediate management. Haemoptysis is a challenging situation because the potential numerous causes lead to strongly different therapeutic options (medical, surgical, systematic embolization). When haemoptysis occurred at the acute phase of pulmonary embolism, anticoagulation should be stopped and inferior vena cava filter is justified. Based on a case report of massive haemoptysis related to pulmonary infarction (i.e., no other causes) in a patient with a unprovoked intermediate high-risk pulmonary embolism, we describe the dilemma set in the paradox between the need for stopping anticoagulation and the need to treat the cause of haemoptysis which is also anticoagulation. If anticoagulation should be stopped, however, the optimal management regarding the use of specific reversal agents or prothrombotic plasma concentrates remains uncertain and weakly documented. After haemoptysis has been resolved, there is also uncertainty on restarting anticoagulation modalities. Regarding long-term management, the decision to stop at three months or to prolong indefinitely based on international recommendation is also challenging in the case of unprovoked severe pulmonary embolism. In this particularly high risk situation, multidisciplinary expertise is essential.
摘要：
咯血是一种潜在的威胁生命的症状,这需要立即管理。咯血是一个具有挑战性的情况，因为潜在的众多原因导致强烈不同的治疗选择(医疗，外科,系统栓塞)。当在肺栓塞的急性期发生咯血时，抗凝应该停止，下腔静脉滤器是合理的。根据与肺梗塞相关的大咯血的病例报告（即，无其他原因)患有无源性中度高危肺栓塞的患者，我们描述了在需要停止抗凝和需要治疗咯血的原因（也是抗凝）之间的矛盾中的两难选择。如果应该停止抗凝，然而,关于使用特异性逆转剂或血栓前血浆浓缩物的最佳管理仍不确定,且文献报道薄弱.咯血解决后,重启抗凝模式也存在不确定性.关于长期管理，在无源性严重肺栓塞的情况下,根据国际建议决定在3个月时停止或无限期延长也具有挑战性.在这种特别高风险的情况下，多学科的专业知识至关重要。
