Chest
ORIGINAL RESEARCHANTITHROMBOTIC THERAPYEarly Anticoagulation Is Associated With Reduced Mortality for Acute Pulmonary Embolism
Section snippets
Patient Selection and Characterization
We conducted a retrospective review of a cohort of adult patients who presented to a single tertiary care ED with acute PE between June 17, 2002, and September 6, 2005. All PE diagnoses were confirmed by CT scan angiography. Patients were excluded if diagnosis was prior to arrival or if anticoagulation was contraindicated. All patients were initially treated with an IV weight-based heparin nomogram similar to the one described by Raschke et al14 as per our institutional practice. This study was
Results
Search of the Mayo Clinic electronic medical record yielded 400 patients seen in the ED between 2002 and 2005 who met the aforementioned criteria for acute PE (Tables 1, 2). Median age was 68.0 years (IQR, 54.0–76.0), with 48.8% men. Patients were hospitalized for a median 4.6 days (IQR, 2.1–6.9). Seventy-seven patients (19.3%) required ICU admission, and the median ICU length-of-stay was 2.0 days (IQR, 1.0–3.0). The median follow-up time was 1,411.9 days (IQR 294.9–1,777.8), and 392 patients
Discussion
Guidelines recommend early anticoagulation for patients with acute PE.3, 17 These guidelines come from data showing that anticoagulation reduces overall mortality and VTE recurrence.6, 9, 11, 12, 13, 21, 22, 23, 24, 25, 26, 27 However, prior studies have not evaluated how the timing of anticoagulation relates to mortality. This study is the first to consider how the timing of anticoagulation is associated with mortality for acute PE. Our data demonstrate reduced in-hospital and 30-day mortality
Conclusions
We provide novel data regarding how the timing of anticoagulation relates to mortality for patients with acute PE. Delayed anticoagulation in our cohort was a risk factor associated with increased mortality. Further investigations are warranted to elucidate the influence of certain demographics and comorbidities, but we nevertheless advocate that quality improvement measures be considered to expedite management of acute PE.
Acknowledgments
Author Contributions: Dr Smith: contributed to collecting and analyzing the data.
Dr Geske: contributed to collecting and analyzing the data.
Dr Maguire: contributed to collecting and analyzing the data.
Mr Zane: contributed to collecting and analyzing the data.
Dr Carter: contributed to providing statistical support.
Dr Morgenthaler: contributed to providing review, guidance, and manuscript preparation.
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential
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Funding/Support: This study was supported by the National Center for Research Resources, a component of the National Institutes of Health (NIH) [Grant 1 UL1 RR024150-01] and the NIH Roadmap for Medical Research. The Center for Translation Science Activities at Mayo Clinic has NIH funding.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).