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Delayed anticoagulation is associated with poor outcomes in high-risk acute pulmonary embolism

Authors
 Sarah Soh  ;  Jeong Min Kim  ;  Jin Ha Park  ;  Shin Ok Koh  ;  Sungwon Na 
Citation
 JOURNAL OF CRITICAL CARE, Vol.32 : 21-25, 2016 
Journal Title
 JOURNAL OF CRITICAL CARE 
ISSN
 0883-9441 
Issue Date
2016
MeSH
Adult ; Aged ; Aged, 80 and over ; Anticoagulants/therapeutic use* ; Clinical Protocols ; Critical Care/methods* ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pulmonary Embolism/diagnosis* ; Pulmonary Embolism/drug therapy* ; Pulmonary Embolism/mortality ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk ; Survival Analysis ; Time Factors ; Treatment Outcome
Keywords
Early anticoagulation ; Heparin ; Prognosis ; Pulmonary embolism
Abstract
PURPOSE: 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. MATERIALS AND 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.
Full Text
http://www.sciencedirect.com/science/article/pii/S0883944115006012
DOI
10.1016/j.jcrc.2015.11.024
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jeongmin(김정민) ORCID logo https://orcid.org/0000-0002-0468-8012
Na, Sungwon(나성원) ORCID logo https://orcid.org/0000-0002-1170-8042
Park, Jin Ha(박진하) ORCID logo https://orcid.org/0000-0002-1398-3304
Soh, Sa Rah(소사라) ORCID logo https://orcid.org/0000-0001-5022-4617
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146618
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