Journal of Thrombosis and Thrombolysis

, Volume 27, Issue 2, pp 154–162

Improving adjunctive treatment in pulmonary embolism and fibrinolytic therapy. The role of enoxaparin and weight-adjusted unfractionated heparin

  • Carlos Jerjes-Sánchez
  • Sergio Villarreal-Umaña
  • Alicia Ramírez-Rivera
  • Anabel Garcia-Sosa
  • Luis Miguel-Canseco
  • Tamara Archondo
  • Esteban Reyes
  • Angel Garza
  • Roberto Arriaga
  • Francisco Castillo
  • Omar Jasso
  • Hector Garcia
  • Martha Bermudez
  • Jose Maria Hernandez
  • Jorge Garcia
  • Pedro Martinez
  • Francisco Rangel
  • Jorge Gutierrez
  • Alfredo Comparan-Nuñez
Article

DOI: 10.1007/s11239-008-0192-3

Cite this article as:
Jerjes-Sánchez, C., Villarreal-Umaña, S., Ramírez-Rivera, A. et al. J Thromb Thrombolysis (2009) 27: 154. doi:10.1007/s11239-008-0192-3

Abstract

Aim 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. Conclusion 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.

Keywords

Pulmonary embolismThrombolysisFibrinolytic therapyEnoxaparinRight ventricular dysfunction

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Carlos Jerjes-Sánchez
    • 1
  • Sergio Villarreal-Umaña
    • 1
  • Alicia Ramírez-Rivera
    • 1
  • Anabel Garcia-Sosa
    • 1
  • Luis Miguel-Canseco
    • 1
  • Tamara Archondo
    • 1
  • Esteban Reyes
    • 1
  • Angel Garza
    • 1
  • Roberto Arriaga
    • 2
  • Francisco Castillo
    • 1
  • Omar Jasso
    • 1
  • Hector Garcia
    • 1
  • Martha Bermudez
    • 1
  • Jose Maria Hernandez
    • 1
  • Jorge Garcia
    • 1
  • Pedro Martinez
    • 1
  • Francisco Rangel
    • 3
  • Jorge Gutierrez
    • 4
  • Alfredo Comparan-Nuñez
    • 5
  1. 1.Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, MonterreySan Pedro Garza GarciaMexico
  2. 2.Hospital de Cardiología CMN, IMSSMexicoMexico
  3. 3.Hospital PEMEX NorteMexicoMexico
  4. 4.Hospital General de Zona No 33, IMSSMonterreyMexico
  5. 5.Hospital General de Especialidades No. 1, IMSSTijuanaMéxico