Early Heparin Beneficial in Pulmonary Embolism

Anticoagulation in emergency department associated with lower mortality rates
By Lindsey Marcellin
HealthDay Reporter

THURSDAY, June 3 (HealthDay News) -- For patients with acute pulmonary embolism (PE), starting heparin early, while the patient is still in the emergency department, is associated with decreased mortality, according to research published in the June issue of Chest.

Sean B. Smith, M.D., of the Mayo Clinic College of Medicine in Rochester, Minn., and colleagues studied 400 consecutive emergency department patients diagnosed with PE to determine the relationship between timing of anticoagulation and survival. Patients were stratified into two groups: those who received intravenous heparin while in the emergency department, and those who received it after admission. PE was diagnosed by computed tomography angiography in all cases.

The researchers found that patients who received heparin in the emergency department had a 1.4 percent in-hospital mortality rate; those who received heparin after admission had a 6.7 percent in-hospital mortality rate. Thirty-day mortality was also significantly lower in the emergency department anticoagulated group than in the group anticoagulated after admission (4.4 versus 15.3 percent). Patients who achieved a therapeutic activated partial thromboplastin time level within a time frame of 24 hours also had lower in-hospital and 30-day mortality rates than did those patients who did not achieve a therapeutic level within that time frame.

"We provide novel data regarding how the timing of anticoagulation relates to mortality for patients with acute PE. Delayed anticoagulation in our cohort was a risk factor associated with increased mortality. Further investigations are warranted to elucidate the influence of certain demographics and comorbidities, but we nevertheless advocate that quality improvement measures be considered to expedite management of acute PE," the authors write.

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