Delayed anticoagulation is associated with poor outcomes in high-risk acute pulmonary embolism

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• 作者：Sarah Soh^a ; ^{yeonchoo@yuhs.ac" class="auth_mail" title="E-mail the corresponding author} ; Jeong Min Kim^a ; ^{ANESJEONGMIN@yuhs.ac" class="auth_mail" title="E-mail the corresponding author} ; Jin Ha Park^a ; ^{REALSUMMER@yuhs.ac" class="auth_mail" title="E-mail the corresponding author} ; Shin Ok Koh^c ; ^{sokoh4679@caumc.or.kr" class="auth_mail" title="E-mail the corresponding author} ; Sungwon Na^a ; ^b ; ^{nswksj@yuhs.ac" class="auth_mail" title="E-mail the corresponding author}
• 关键词：IVC ; inferior vena cava ; IQR ; interquartile range ; CHF ; chronic heart failure ; COPD ; chronic pulmonary obstructive disease ; CT ; computed tomography ; ICU ; intensive care unit ; ED ; emergency department ; PE ; pulmonary embolism ; SBP ; systolic blood pressure ; aPTT ; activated partial thromboplastin time ; RV ; right ventricle ; LV ; left ventricle
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：32
• 期：Complete
• 页码：21-25
• 全文大小：354 K

文摘

Early diagnosis and timely treatment are essential to improve the outcomes of pulmonary embolism (PE), but no study has investigated the impact of anticoagulation timing on clinical outcomes in high-risk acute PE patients. We analyzed the relationship between early anticoagulation initiation and in-hospital mortality in high-risk acute PE patients at the intensive care unit (ICU) of a teaching hospital.

Materials and methods

Seventy-three PE patients admitted to the ICU were included in this retrospective study. Demographic, clinical, radiological, and therapeutic data were collected on ICU admission, and the timings of diagnosis and anticoagulation initiation were analyzed.

Results

The number of survivors was 67. The median time from hospital arrival to the start of anticoagulation therapy was significantly lower in survivors (3.6 [2.6-5.0] hours) than nonsurvivors (5.7 [4.5-14.9] hours; P = .03). However, the median time required to achieve a therapeutic anticoagulation level was comparable between survivors and nonsurvivors (12.0 [9.5-19.5] vs 16.4 [10.7-27.4] hours; P = .488). Ventilatory support and vasopressor use were found to be associated with higher in-hospital mortality.

Conclusions

Delayed anticoagulation is an important prognostic factor of poor outcomes in high-risk acute PE patients.