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Original Research: ANTITHROMBOTIC THERAPY |

Early Anticoagulation Is Associated With Reduced Mortality for Acute Pulmonary Embolism

Sean B. Smith, MD; Jeffrey B. Geske, MD; Jennifer M. Maguire, MD; Nicholas A. Zane, BA; Rickey E. Carter, PhD; Timothy I. Morgenthaler, MD, FCCP; Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology
Author and Funding Information

From the Department of Internal Medicine (Drs Smith, Geske, and Maguire), the Mayo Medical School (Mr Zane), the Department of Health Sciences Research (Dr Carter), Center for Translation Science Activities, and the Department of Pulmonary and Critical Care Medicine (Dr Morgenthaler), Mayo Clinic College of Medicine, Rochester, MN.

Correspondence to: Timothy I. Morgenthaler, MD, FCCP, Gonda 18-130, 200 First St SW, Rochester, MN 55905; e-mail: tmorgenthaler@mayo.edu


Funding/Support: This study was supported by the National Center for Research Resources, a component of the National Institutes of Health (NIH) [Grant 1 UL1 RR024150-01] and the NIH Roadmap for Medical Research. The Center for Translation Science Activities at Mayo Clinic has NIH funding.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1382-1390. doi:10.1378/chest.09-0959
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Background:  Acute pulmonary embolism (PE) may be rapidly fatal if not diagnosed and treated. 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 patients in the ED diagnosed with acute PE by CT scan 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 ICU lengths of stay, hemorrhagic events on heparin, and recurrent venous thromboembolism 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% vs 6.7%; P = .009) and 30-day (4.4% vs 15.3%; P < .001) mortality rates as compared with patients given heparin after admission. Patients who achieved a therapeutic aPTT within 24 h had lower in-hospital (1.5% vs 5.6%; P = .093) and 30-day (5.6% vs 14.8%; P = .037) mortality rates as compared with patients who achieved a therapeutic aPTT after 24 h. 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 to assess the usefulness of modifications to hospital protocols.

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