title: Improving adjunctive treatment in pulmonary embolism and fibrinolytic therapy. The role of enoxaparin and weight-adjusted unfractionated heparin.
abstract: OBJECTIVE
  The role of enoxaparin and weight-adjusted unfractionated heparin (UH) as adjunct to fibrinolytic therapy in pulmonary embolism is unknown.
  
  
  METHODS
  In a prospective, open-label, controlled multicenter trial, 80 patients with high-risk pulmonary embolism were enrolled. Forty patients received alteplase infusion plus weight-adjusted UH (24-48 h) and then enoxaparin (7 days). In control group, UH standard regimen was used. There were not differences on pulmonary embolism extension, (P 0.63) and right ventricular hypokinesis (P 0.07) in both groups. In terms of in-hospital survival (P 0.009), escalation treatment (P < 0.001) and in-hospital stay (P < 0.001) study group had better outcome than opposite group. In a 30 (P < 0.001) and 90 (P < 0.001) days follow-up pulmonary perfusion was improved in patients who received enoxaparin versus heparin alone without increasing major bleeding complications.
  
  
  CONCLUSIONS
  Enoxaparin and weight-adjusted intravenous UH as adjunct to 1-h alteplase infusion improve in-hospital and follow-up outcome compared to heparin alone in high-risk PE.
authors.affiliation: Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey, Santander 316, Colonia Bosques de San Angel, Sector Palmillas, San Pedro Garza Garcia, NL CP 66290, Mexico. jerjes@prodigy.net.mx
authors.forename: Carlos
authors.initials: C
authors.lastname: Jerjes-Sánchez
authors.forename: Sergio
authors.initials: S
authors.lastname: Villarreal-Umaña
authors.forename: Alicia
authors.initials: A
authors.lastname: Ramírez-Rivera
authors.forename: Anabel
authors.initials: A
authors.lastname: Garcia-Sosa
authors.forename: Luis
authors.initials: L
authors.lastname: Miguel-Canseco
authors.forename: Tamara
authors.initials: T
authors.lastname: Archondo
authors.forename: Esteban
authors.initials: E
authors.lastname: Reyes
authors.forename: Angel
authors.initials: A
authors.lastname: Garza
authors.forename: Roberto
authors.initials: R
authors.lastname: Arriaga
authors.forename: Francisco
authors.initials: F
authors.lastname: Castillo
authors.forename: Omar
authors.initials: O
authors.lastname: Jasso
authors.forename: Hector
authors.initials: H
authors.lastname: Garcia
authors.forename: Martha
authors.initials: M
authors.lastname: Bermudez
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Hernandez
authors.forename: Jorge
authors.initials: J
authors.lastname: Garcia
authors.forename: Pedro
authors.initials: P
authors.lastname: Martinez
authors.forename: Francisco
authors.initials: F
authors.lastname: Rangel
authors.forename: Jorge
authors.initials: J
authors.lastname: Gutierrez
authors.forename: Alfredo
authors.initials: A
authors.lastname: Comparan-Nuñez
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin; D010959:Tissue Plasminogen Activator