Early Anticoagulation is Associated with Reduced Mortality for Acute Pulmonary Embolism.
Chest. 2010 Jan 15;
Authors: Smith SB, Geske JB, Maguire JM, Zane NA, Carter RE, Morgenthaler TI
BACKGROUND: Acute pulmonary embolism (PE) may be rapidly fatal if not diagnosed and treated. Intravenous (IV) heparin reduces mortality and recurrence of PE, but the relationship between survival and timing of anticoagulation has not been extensively studied. METHODS: We studied 400 consecutive emergency department (ED) patients diagnosed with acute PE by CT angiography and treated in the hospital with IV unfractionated heparin from 2002 to 2005. Patients received heparin either in the ED or after admission. Time from ED arrival to therapeutic activated partial thromboplastin time (aPTT) was calculated. Outcomes included in-hospital and 30-day mortality, hospital and intensive care unit (ICU) lengths-of-stay, hemorrhagic events on heparin, and recurrent venous thromboembolism (VTE) within 90 days. RESULTS: In-hospital and 30-day mortality rates were 3.0% and 7.7%, respectively. Patients who received heparin in the ED had lower in-hospital (1.4% versus 6.7%, p=0.009) and 30-day (4.4% versus 15.3%, p<0.001) mortality rates as compared to patients given heparin after admission. Patients who achieved a therapeutic aPTT within 24 hours had lower in-hospital (1.5% versus 5.6%, p=0.093) and 30-day (5.6% versus 14.8%, p=0.037) mortality rates as compared to patients who achieved a therapeutic aPTT after 24 hours. In multiple logistic regression models, receiving heparin in the ED remained predictive of reduced mortality, and ICU admission remained predictive of increased mortality. CONCLUSIONS: We report an association between early anticoagulation and reduced mortality for patients with acute PE. We advocate further study with regard to comorbidities in order to assess the utility of modifications to hospital protocols.
PMID: 20081101 [PubMed - as supplied by publisher]