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

Authors

    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Sergio Villarreal-Umaña
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Alicia Ramírez-Rivera
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Anabel Garcia-Sosa
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Luis Miguel-Canseco
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Tamara Archondo
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Esteban Reyes
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Angel Garza
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Roberto Arriaga
    • Hospital de Cardiología CMN, IMSS
  • Francisco Castillo
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Omar Jasso
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Hector Garcia
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Martha Bermudez
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Jose Maria Hernandez
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Jorge Garcia
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Pedro Martinez
    • Hospital de Enfermedades Cardiovasculares y del Torax, IMSS, Monterrey
  • Francisco Rangel
    • Hospital PEMEX Norte
  • Jorge Gutierrez
    • Hospital General de Zona No 33, IMSS
  • Alfredo Comparan-Nuñez
    • Hospital General de Especialidades No. 1, IMSS
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