We need to takeappropriate
measures to prevent
pulmonarythromboembolism
during your hospitalstay.

Gunma University Hospital
Department of Healthcare Quality and Safety/
Department of Cardiovascular Medicine

⚫ Real-life story from Yuriko Tanaka*

3⚫ Preventing pulmonary thromboembolism
during your hospital stay

11

2
*Name changed to protect privacy

When I went
to the hospitalfor irregularvaginalbleeding, I
wasdiagnosed
with uterine
cancer.

But I've
never
had aserious
illness in
my life...

What?!

YurikoTanaka(age 62)

I had tostay in thehospitalfor a whileto havethe cancer
removed.

I haven't
had surgery
since myC-section…

Now I’d like togo over somedetails about
your hospitalstay.

Fortunately,
we didn't findany distantmetastasis.

3Ms. Tanaka,
you have
Stage IIIcancer, withlymph nodemetastasis.

But why
would theygive medrugs thatmake mebleed moreeasily after
surgery?

Pulmonary
To prevent
thrombopulmonary
embolism?
thromboI don't
embolism,know what
it is, but itsounds
we’ll use pumpscary.
devices to massage
your legs, and give
you medication toreduce bloodclotting aftersurgery.

The
operation
took over
8 hours.

Oh good,
now I canrelax.

We will now
begin theoperation.

It seems
they got it
done safely
while I was
asleepundergeneralanesthesia.

…TanakaThe
operation
was asuccess.

Ms.
Tanaka,

4

But
then,
thingstook aturn fortheworse.

I thought thatonce theoperation wasdone, I'd justbe monitored
for a bit andwouldn’t haveanything else
to worry
about.

Starting
today, we’ll begiving you
medication toreduce bloodclotting.

I see, thisis themedication
the doctortold me
about
before theoperation.

*Hrrgh*Okay, I'llhelp you!

I need touse thebathroom.

Nextday

2 daysaftersurgery*gasp*
I can’tbreathe…
Are youokay?!?

Arrgh…

*gasp*

5Doctor,Please cometo Room
123 rightaway!

Uugh…

*slam*Can youhear me?

Ican’t…

Ms. Tanaka!
breathe…

It could bePTE(pulmonarythromboembolism)…
Get me a
cardiologist!

6

*fssh**fssh*

She’s
consciousand alert.

The
cardiologist
is here!
Can feel apulse too.

A CT scanshowedclots inboth of mypulmonary
arteries.

7

It’s still a
bit hard tobreathe,
but I’mfeeling a
lot better
now.

Oneweeklater*clack*That’s good.
We’ll justgive youblood
thinners a
bit longer
and you’ll be
all better.

*click*Ms. Tanaka, you
had somethingcalled "economy
class syndrome."

8This can also
happen when you
have surgery
under generalanesthesia or are
on bed rest,
because naturally
you can’t moveyour legs.

whichcancause a
blood
clot.

You’ve probably
heard thatwhen you sit
still for a longtime in a
crampedairplane, theblood in yourleg veins starts
to pool,*gasp*
but if it escapes into
the bloodstream
toward the heart, it
can cause
pulmonarythromboembolism,
which is a blockagein the pulmonary
artery.

If the clot stops
in the leg, it will
only causeswelling,*gasp*

But didn’t I get
those injections
to prevent
blood clots?

You were at highrisk due to having
cancer and obesity.

9in the worstcase
scenario you
might evenhave died.

Light activity soon after
surgery

Leg exercises, stepping, andwalking to prevent blood clots

If we had done
nothing to prevent
it, a larger clot
could have gotten
into yourbloodstream,and if you needed
to go on aventilator or ECMO,This isn't
somethingthat’s 100%
preventable.

Compression stockings

There
are fourways toprevent
it.

Compress thelegs to stop
blood frompoolingIntermittent pneumatic
compression devices
Blood thinners

Medication to prevent
blood from clotting

System that uses pumped
air to massage the legs

I'm so gladthese things
you didprevented itfrom becoming
too serious.

10I didn't
know
that.

This canhappen in
any kind ofsurgery, notjust
gynecologicalsurgery.

Pulmonary thromboembolism (economy class syndrome) in
hospitalized patients
1. What is pulmonary thromboembolism (PTE)?
PTE is a disease where a blood clot (thrombus) blocks the arteries of the lungs. In mostcases, the clot first forms in the leg veins. This is called “deep vein thrombosis” (DVT).
The clot travels through the bloodstream to the heart and then to the pulmonary artery,causing PTE.
Another term for PTE is “economy class syndrome,” because it can occur after sitting in acramped economy-class airplane seat for a long time. Once a clot progresses to PTE, therisk of death is very high.

2. What are the symptoms of PTE?
(1) Difficulty breathing and rapid/irregular heartbeats (2) Chest pain (3) Fainting andshock (4) When accompanied by DVT: pain, swelling, and changes in skin color in theaffected leg.

3. What situations increase the likelihood of PTE?
Prolonged bed rest can lead to PTE. Patients who are having surgery, need bed rest, or
are unable to move after a fracture or traumatic injury are more likely to get PTE.
People with obesity and elderly adults are also considered to be at higher risk. In rarecases, abnormalities in coagulation (the blood's ability to clot) that are present at birth
can also cause PTE.
4. Risk of PTE when having surgery
We comprehensively determine the risk of PTE for patients having surgery, based on thepatient's individual risk factors for blood clots (including age, history of venous
thromboembolism, paralysis) and with consideration to factors such as bleeding risk.
Your doctor will evaluate risk for your particular type of surgery.

Get your legs moving!
Ways to Prevent
PTE(1) Light activity soon aftersurgery(2) Good fluid intake(3) Exercise therapy(4) Wearing compressionstockings(5) Intermittent pneumaticcompression(6) Medication (bloodthinners)

Lift toes

Rotateankles

11

Squeeze together
and separate toes

Raise andlower heelson tiptoe

MassagecalvesNote to our Patients
Gunma University Hospital provides
information on prevention of
pulmonary thromboembolism to patients whoare staying in the hospital for surgery orneed bed rest for 48 hours or longer.
We also ask for written informed consent toperform preventive measures.

Thank you for your understanding.