Improving adjunctive treatment in pulmonary embolism and fibrinolytic therapy. The role of enoxaparin and weight-adjusted unfractionated heparin.
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.
Jerjes-Sánchez
Carlos
C
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
Villarreal-Umaña
Sergio
S
Ramírez-Rivera
Alicia
A
Garcia-Sosa
Anabel
A
Miguel-Canseco
Luis
L
Archondo
Tamara
T
Reyes
Esteban
E
Garza
Angel
A
Arriaga
Roberto
R
Castillo
Francisco
F
Jasso
Omar
O
Garcia
Hector
H
Bermudez
Martha
M
Hernandez
Jose Maria
JM
Garcia
Jorge
J
Martinez
Pedro
P
Rangel
Francisco
F
Gutierrez
Jorge
J
Comparan-Nuñez
Alfredo
A
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
D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin; D010959:Tissue Plasminogen Activator