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Early anticoagulation may improve survival after pulmonary embolism

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Starting heparin in the emergency department (ED) rather than after admission may improve the survival of patients with acute pulmonary embolism (PE), according to a Mayo Clinic study.

In-hospital mortality for patients receiving ED anticoagulation was 1.4%, much lower than the 6.7% in patients treated after hospital admission (p = 0.009).

“Intravenous heparin reduces mortality and recurrence of PE, but the relationship between survival and timing of anticoagulation has not been extensively studied,” senior author Dr. Timothy I. Morgenthaler and colleagues note.

In their January 15th online publication in Chest, the researchers report on their retrospective analysis of 400 consecutive patients who presented to the Rochester, Minnesota, center with acute PE. Patients were diagnosed at a median interval of 2.4 hours after arrival.

Two hundred eighty patients (70%) received heparin in the ED (early), including 20 who were not yet diagnosed with PE. The median time from emergency department arrival to therapeutic activated partial thromboplastin time (aPTT) was 10.8 hours, and 325 patients (85.8%) achieved a therapeutic time within 24 hours of arrival.

Overall, the in-hospital and 30-day mortality rates were 3.0% and 7.7%, respectively.

In addition to having a lower in-hospital mortality rate, early anticoagulation patients had lower 30-day mortality than patients treated with heparin post-admission: 4.4% vs. 15.3% (p < 0.001).

Similarly, the authors found that patients who achieved a therapeutic aPTT within 24 hours of arrival had lower in-hospital (1.5% vs. 5.6%) and 30-day (5.6% vs. 14.8%) mortality compared to patients who did not.

Independent correlates of increased mortality included not receiving heparin in the ED and admission to the intensive care unit.

“Further investigations are warranted to elucidate the influence of certain demographics and comorbidities, but we nevertheless advocate that quality improvement measures be considered to expedite management of acute PE,” the authors state.

Reference:
Chest 2010.