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Abstract: Poster Presentations |

OPTIMAL ANTICOAGULATION REGIMEN POST-FIBRINOLYSIS IN ACUTE PULMONARY EMBOLISM PATIENTS: SHOULD WE STICK WITH THE GUIDELINES? FREE TO VIEW

Elisabete Jorge; Rui Baptista; Rogério Teixeira; Paulo Mendes; Sφlvia Monteiro; Francisco Gonτalves; Graτa Castro; Pedro Monteiro; Mario Freitas; Luis Augusto Providência
Author and Funding Information

Coimbra University Hospital and Medical School, Coimbra, Portugal


Chest


Chest. 2009;136(4_MeetingAbstracts):149S. doi:10.1378/chest.136.4_MeetingAbstracts.149S-b
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Abstract

PURPOSE:  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).

METHODS:  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%).

RESULTS:  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.

CONCLUSION:  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.

CLINICAL IMPLICATIONS:  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.

DISCLOSURE:  Elisabete Jorge, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, November 4, 2009

12:45 PM - 2:00 PM


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