Early Anticoagulation Is Associated With Reduced Mortality for Acute Pulmonary Embolism

Smith, Sean B.; Geske, Jeffrey B.; Maguire, Jane; Zane, Nicholas A.; Carter, Rickey E.; Morgenthaler, Timothy I.

doi:10.1378/chest.09-0959

Cited by 234 publications

(174 citation statements)

References 46 publications

(40 reference statements)

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“…Third, data are lacking to compare the availability and contemporaneous use of risk stratification methods, including serum biomarkers, for patients diagnosed with PE. Fourth, no prior data have documented the frequency of use of empiric anticoagulation in the ED, an intervention that may affect outcome (5).…”

Section: Discussionmentioning

confidence: 99%

“…Prior work has suggested that delays in anticoagulation are associated with increased short-term adverse events, including recurrence of VTE (18,19). Two independent reports have found an increase in mortality in ED patients with PE who did not receive heparin until after hospital admission, compared with patients who received heparin in the ED (5,18,19). Moreover, Smith et al (5) found that the time to heparin administration was an independent predictor of mortality in a logistic regression equation that was adjusted for the cumulative effect of comorbidities.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Characteristics, Management, and Outcomes of Patients Diagnosed With Acute Pulmonary Embolism in the Emergency Department

Pollack¹,

Schreiber²,

Goldhaber³

et al. 2011

Journal of the American College of Cardiology

490

281

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics, Management, and Outcomes of Patients Diagnosed With Acute Pulmonary Embolism in the Emergency Department

Pollack¹,

Schreiber²,

Goldhaber³

et al. 2011

Journal of the American College of Cardiology

490

281

View full text Add to dashboard Cite

show abstract

“…The therapy of IV UFH requires monitorization on activated partial thromboplastin time, so patients with acute PE need hospitalization. The efficacy of IV UFH also depends upon achieving a therapeutic level of heparin within the first 24 h of treatment [11]; because achieving this sometimes fails, inadequate initial heparin therapy may increase the probability of recurrent PE for at least 3 months despite ongoing therapeutic anticoagulation [12]. …”

Section: Discussionmentioning

confidence: 99%

Low-Molecular-Weight Heparin Use with Thrombolysis: Is it Effective and Safe? Ten Years' Clinical Experience

et al. 2013

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Background: There is no data on the use of subcutaneous low-molecular-weight heparin (SC LMWH) in cases that require thrombolysis. Objective: Having used SC LMWH with thrombolytics for more than 10 years, we aimed to review our data, share our experiences and find out whether the use of SC LMWH with thrombolytics had been effective and safe. Method: This is a retrospective cohort study. Patients who were diagnosed as acute pulmonary embolism (PE) and received either SC LMWH treatment or SC LMWH with thrombolytics in our hospital (a tertiary hospital) between 2000 and 2010 were included in the study. For both treatments, the rates of mortality and complications were calculated. Results: A total of 392 patients, 210 female (53.5%) and 182 male (46.5%) with an average age of 60 years, ±16 SD, with acute PE, were included in the study. Of these patients, 107 (27.2%) were massive and 285 (72.8%) were nonmassive and were administered SC LMWH plus thrombolytics and only SC LMWH, respectively. The mortality rate was 16.8% (18 of 107) in patients who were massive and 3.5% (10 of 285) for those who were nonmassive (p < 0.001). Major hemorrhage occurred in 3.7% (n = 4) and 0.7% (n = 2) and minor hemorrhage in 12.1% (n = 13) and in 3.8% (n = 11) of the cases who received SC LMWH plus thrombolytics and SC LMWH, respectively. Conclusion: SC LMWH use with thrombolytics seems to be feasible and safe. Prospective, large, randomized control trials are still required in order to confirm these results.

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“…If untreated, it has an overall mortality of up to 26% [12]. Anticoagulation reduces mortality and recurrence of pulmonary embolism [13]. All our patients were asymptomatic, and all of them had undergone a prior staging contrast-enhanced CT that missed the thrombotic disease in half of them because of the inadequacy of the CT protocol, which should have been a CT pulmonary angiography.…”

Section: Discussionmentioning

confidence: 99%

Distant Thromboembolic Disease Diagnosed by Endoscopic Ultrasound in Pancreatic Cancer: A Case Series

Atalaia-Martins

Pinto-Marques

Mocanu

et al. 2018

GE Port J Gastroenterol

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Thrombosis and cancer have a very well-known association. Pancreatic cancer has the highest risk for thrombotic events amongst gastrointestinal cancers and is a leading direct cause of death in cancer patients. We assessed the role of endoscopic ultrasound (EUS) in identifying distant thrombotic events in pancreatic cancer patients. We performed a retrospective review of all EUS cases for pancreatic cancer in two centers and assessed all remotely located thrombotic events diagnosed. In a period of 6 months, a total of 55 EUS for pancreatic neoplasm were performed and the following thrombotic events were identified in 4 patients (7.3%): pulmonary thromboembolism (75%) and vena cava thrombosis (25%). The authors present these 4 cases of thrombotic disease identified by EUS, 50% of them previously missed by noninvasive imaging. EUS evaluation is not seldom limited to the targeted lesion prior identified in other imaging studies. Vascular thrombus can be an incidental finding on EUS. If untreated, pulmonary embolism has a high overall mortality. This series underlines the importance of a systematic, station approach EUS technique, namely in the mediastinum, regardless of the clinical indication.

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Early Anticoagulation Is Associated With Reduced Mortality for Acute Pulmonary Embolism

Abstract: We report an association between early anticoagulation and reduced mortality for patients with acute PE. We advocate further study with regard to comorbidities to assess the usefulness of modifications to hospital protocols.

Cited by 234 publications

References 46 publications

Clinical Characteristics, Management, and Outcomes of Patients Diagnosed With Acute Pulmonary Embolism in the Emergency Department

Clinical Characteristics, Management, and Outcomes of Patients Diagnosed With Acute Pulmonary Embolism in the Emergency Department

Low-Molecular-Weight Heparin Use with Thrombolysis: Is it Effective and Safe? Ten Years' Clinical Experience

Distant Thromboembolic Disease Diagnosed by Endoscopic Ultrasound in Pancreatic Cancer: A Case Series

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