To compare the intra-hospitalar outcomes of a heparin-only, enoxaparin-only or heparin-bridging-to-enoxaparin strategies after alteplase administration for treatment of pulmonary embolism (PE).
A total of 91 patients with PE admitted for fibrinolysis in a single intensive care unit were studied regading clinical, laboratory and outcomes data. Alteplase was administred to all patients with anatomically extense intra-pulmonary thrombi and/or echocardiographic signs of right ventricular overload/dysfunction. Patients were divided in 3 groups: A - heparin only (n = 46, 50.5%); B - enoxaparin only (n = 13; 14.3%); C - heparin bridging to enoxaparin (n = 32; n = 35.2%).
No differences in gender were found among groups, as well as prior history of pulmonary embolism or other risk factors, except for cancer patients, that were more often tretaed with heparin-only strategy. The mean duration of heparin therapy in group A patients was 4.5+/−2.4 days and in group C 5.4+/−5.0 days. Regarding enoxaparin-only strategy, the mean duration was 5.5+/-2.1 days. No differences were elicited regarding in-hospital mortality (9.8 vs. 4.8 vs.2.8%, p = 0.397). Although not statistically significant (p = 0.354), there was an important trend towards more bleeding in the enoxaparin-only (38.5%) vs. heparin-only (19.6%) or heparin-enoxaparin (21.9%) groups. These bleeds were also clinically significative (major) in a greater fraction of enoxaparin patients (50.0%) than with heparin (22.2%) or heparin-enoxaparin (14.3%), p = 0.407.
In our population, we verified an important trend towards more bleeding in the group medicated with enoxaparin than in the groups medicated with heparin or heparin-enoxaparin.
The choice of the better anticoagulant drug after fibrinolysis for PE is still a matter of debate.This result should be taken into consideration when choosing the best anticoagulant regimen post-fibrinolysis in PE patients.
Elisabete Jorge, No Financial Disclosure Information; No Product/Research Disclosure Information