title: Delayed anticoagulation is associated with poor outcomes in high-risk acute pulmonary embolism.
abstract: OBJECTIVE
  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.
  
  
  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.affiliation: 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.
authors.forename: Sarah
authors.initials: S
authors.lastname: Soh
authors.affiliation: 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.
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: Kim
authors.affiliation: 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.
authors.forename: Jin Ha
authors.initials: JH
authors.lastname: Park
authors.affiliation: 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.
authors.forename: Shin Ok
authors.initials: SO
authors.lastname: Koh
authors.affiliation: 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.
authors.forename: Sungwon
authors.initials: S
authors.lastname: Na
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Early anticoagulation; Heparin; Prognosis; Pulmonary embolism