Sarah Soh1, Jeong Min Kim2, Jin Ha Park3, Shin Ok Koh4, Sungwon Na5. 1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea. Electronic address: yeonchoo@yuhs.ac. 2. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea. Electronic address: ANESJEONGMIN@yuhs.ac. 3. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea. Electronic address: REALSUMMER@yuhs.ac. 4. Departments of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, 120 Heukseok-ro, Dongjak-gu, Seoul 156-860, Republic of Korea. Electronic address: sokoh4679@caumc.or.kr. 5. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea; Department of Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea. Electronic address: nswksj@yuhs.ac.
Abstract
PURPOSE: 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.
PURPOSE: 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.
Authors: Christine M Groth; Nicole M Acquisto; Colin Wright; Mark Marinescu; Scott McNitt; Ilan Goldenberg; Scott J Cameron Journal: J Am Coll Clin Pharm Date: 2021-11-22
Authors: Stephan Nopp; Karin Janata-Schwatczek; Helmut Prosch; Ihor Shulym; Oliver Königsbrügge; Ingrid Pabinger; Cihan Ay Journal: Res Pract Thromb Haemost Date: 2020-06-25