Comparison of LMWH Versus UFH for Hemorrhage and Hospital Mortality in the Treatment of Acute Massive Pulmonary Thromboembolism After Thrombolytic Treatment
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Current guidelines recommend the use of low molecular weight heparin (LMWH) for most haemodynamically stable patients with pulmonary thromboembolism (PTE), however, it is not clear whether LMWH is preferable to unfractionated heparin (UFH) for the treatment of massive PTE. We aimed to compare the use of LMWH versus UFH after thrombolytic treatment in the management of acute massive PTE for hemorrhage and hospital mortality.
The study, a randomized, single center, parallel design trial, included the patients who had confirmed the diagnosis of massive PTE according to clinical findings and computerized thorax angiography and no contraindication to the treatment between January 2011 and October 2013. After thrombolytic treatment, the patients assigned to therapy with LMWH or UFH. Any hemorrhage, major hemorrhage, and hospital mortality were assessed.
A total of 121 patients, 71 female (58.7 %) and 50 male (41.3 %), who had massive PTE with an average age 62.6 ± 15.7 (ranges 22–87) were included for analyses in the study. They were allocated to either LMWH (n = 60) or UFH (n = 61) group. Although the occurrence of any adverse event (21.7 vs 27.9 %) and each individual type of adverse event were all lower in the LMWH group compared to UFH group (6.7 vs 11.5 %, 3.3 vs 9.8 %, and 15.0 vs 19.7 % for death, major hemorrhage, and any hemorrhage, respectively), the differences were not statistically significant.
Our findings suggest that LMWH might be a better option in the management of the patients with massive PTE. Multi-center larger randomized controlled trials are required to confirm our results.
KeywordsPulmonary thromboembolism Thrombolytic treatment Low molecular weight heparin Unfractionated heparin Mortality
The authors acknowledge and thank the American Thoracic Society Methods in Epidemiologic, Clinical and Operations Research (MECOR) Program, and specifically the faculty of the ATS MECOR Global Course (William Vollmer and Cecilia M. Patino-Suttan), for their invaluable help in the development of our research skills and our love for research.
Conflict of interest
The authors declare that they have no conflict of interest in the publication of this article.
- 3.Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e419S–e494SPubMedCentralPubMedGoogle Scholar
- 5.Erkens PM, Prins MH (2010) Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev :CD001100Google Scholar
- 6.Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29:2276–2315PubMedCrossRefGoogle Scholar
- 8.Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123:1788–1830PubMedCrossRefGoogle Scholar
- 9.Jerjes-Sanchez C, Villarreal-Umana S, Ramirez-Rivera A, Garcia-Sosa A, Miguel-Canseco L, Archondo T et al (2009) Improving adjunctive treatment in pulmonary embolism and fibrinolytic therapy. The role of enoxaparin and weight-adjusted unfractionated heparin. J Thromb Thrombolysis 27:154–162PubMedCrossRefGoogle Scholar
- 11.van Den Belt AG, Prins MH, Lensing AW, Castro AA, Clark OA, Atallah AN, et al (2000) Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev :CD001100Google Scholar
- 14.Akl EA, Labedi N, Terrenato I, Barba M, Sperati F, Sempos EV, et al (2011) Low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer. Cochrane Database Syst Rev :CD009447Google Scholar
- 15.Junqueira DR, Perini E, Penholati RR, Carvalho MG (2012) Unfractionated heparin versus low molecular weight heparin for avoiding heparin-induced thrombocytopenia in postoperative patients. Cochrane Database Syst Rev 9:CD007557Google Scholar
- 16.Sandercock P, Counsell C, Stobbs SL (2005) Low-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischaemic stroke. Cochrane Database Syst Rev :CD000119Google Scholar
- 17.van Dongen CJ, van den Belt AG, Prins MH, Lensing AW (2004) Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev :CD001100Google Scholar
- 18.Marshall PS, Matthews KS, Siegel MD (2011) Diagnosis and Management of Life-Threatening Pulmonary Embolism. J Intensive Care Med [Epub ahead of print]Google Scholar
- 25.Marti C, John G, Konstantinides S, Combescure C, Sanchez O, Lankeit M, Meyer G, Perrier A (2014) Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis. Eur Heart J [Epub ahead of print]Google Scholar
- 26.Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, Kumbhani DJ, Mukherjee D, Jaff MR, Giri J (2014) Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA 311:2414–2421PubMedCrossRefGoogle Scholar