title: Should Low-Molecular-Weight Heparin be Preferred Over Unfractionated Heparin After Thrombolysis for Severity Pulmonary Embolism?
abstract: OBJECTIVE
  The role of low-molecular-weight heparin (LMWH) in managing nonmassive pulmonary embolism (PE) is well known. In unstable cases, especially after thrombolytic therapy for massive PE, unfractionated heparin (UFH) is preferred for PE management. This study aimed to investigate the effectiveness and safety of LMWH after thrombolytic therapy.
  
  
  METHODS
  A prospective, observational multicenter trial was performed in 249 patients with acute PE who required thrombolysis. Massive and submassive PEs were categorized into 2 groups depending on whether they were treated with LMWH or UFH after thrombolytic treatment. The primary end point was all-cause mortality during the first 30 days; the secondary end point included all-cause mortality, nonfatal symptomatic recurrent PEs, or nonfatal major bleeding.
  
  
  RESULTS
  The mean age at diagnosis was 60.7 ± 15.5 years. The PE severity was massive in 186 (74.7%) patients and submassive in 63 (25.3%). The incidence of all-cause 30-day death was 8.2% and 17.3% in patients with LMWH and UFH, respectively (P = .031). Major hemorrhage occurred in 4% (n = 5) and 7.9% (n = 10) of patients and minor hemorrhage occurred in 9% (n = 11) and 13.4% (n = 17) of the cases treated with LMWH and UFH, respectively.
  
  
  CONCLUSIONS
  These results suggest that LMWH treatment can be used safely in patients with PE after thrombolytic therapy.
authors: Department of Pulmonary Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey asenturk1967@yahoo.com.
authors: Aysegul
authors: A
authors: Senturk
authors: Department of Pulmonary Medicine, Atatürk University School of Medicine, Erzurum, Turkey.
authors: Elif Yilmazel
authors: EY
authors: Ucar
authors: Department of Pulmonary Medicine, Cumhuriyet University, School of Medicine, Sivas, Turkey.
authors: Serdar
authors: S
authors: Berk
authors: Department of Pulmonary Medicine, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.
authors: Tevfik
authors: T
authors: Ozlu
authors: Department of Pulmonary Medicine, Bülent Ecevit University School of Medicine, Zonguldak, Turkey.
authors: Bulent
authors: B
authors: Altınsoy
authors: Department of Pulmonary Medicine, Istanbul Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital, İstanbul, Turkey.
authors: Gul
authors: G
authors: Dabak
authors: Department of Pulmonary Medicine, Trakya University, School of Medicine, Edirne, Turkey.
authors: Ebru
authors: E
authors: Cakır
authors: Department of Pulmonary Medicine, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors: Esra Ekbic
authors: EE
authors: Kadıoglu
authors: Department of Pulmonary Medicine, Dicle University School of Medicine, Diyarbakır, Turkey.
authors: Hadice Selimoglu
authors: HS
authors: Sen
authors: Department of Pulmonary Medicine, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.
authors: Savas
authors: S
authors: Ozsu
mesh_terms: D000208:Acute Disease; D000368:Aged; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy
chemical_list: D006495:Heparin, Low-Molecular-Weight
keywords: low-molecular-weight heparin; pulmonary thromboembolism; unfractionated heparin