Source: Annual Congress 2003 - Pulmonary hypertension
Disease area: Pulmonary vascular diseases

Abstract

Purpose: thrombolytic therapy (TT) in pulmonary embolism (PE) remains controversial. Low molecular weight heparin (LMWH) role is unknown. We conducted a multicenter study in PE and right ventricular hypokinesis (RVH) to investigate if TT plus LMWH versus heparin alone reduce mortality and recurrence. Diagnostic workup: proved submassive or massive PE by: high clinical suspicion, echocardiography, high probability V/Q lung scans, DVT venography. Pts in TT group : 1h alteplase infusion, (bolus 20 mg and 80 mg/ 1h) followed by non-fractionated heparin infusion started at 1000 U/hour (TTP 2.0 – 2.5) . Then enoxaparin 1 mg/kg/12 h/7 days. Heparin group: pts with absolute contraindication to TT received non-fractionated heparin infusion ( 5 - 7 days). In both groups warfarin was started in day one (INR 2.5 – 3.5). A second or rescue TT for failure or recurrence. At discharge 6 month anticoagulation and follow-up. Statistics: chi square, student T test, ANOVA.Results: from 2002 to 2003, 40 consecutive pts; TT 25 pts and Heparin 15 pts. Both group had similar degrees of pulmonary arterial hypertension, (PNS) perfusion segmental defects (PNS) and RVH (PNS) Mortality (0.001) and recurrence (0.004) was higher in Heparin group than TT group. In both groups, no differences in major bleeding. (PNS) Conclusions: preliminary results suggest that one hour alteplase infusion plus LMWH may improve the clinical course of pts with PE. Larger sample of patientes are needed to confirm these findings.

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C. Jerjes-Sanchez, S. Villarreal, A. Ramirez-Rivera, R. Arriaga, F. Rangel (Monterrey, Mexico City, Mexico). One hour alteplase infusion plus low molecular weight heparin versus heparin alone in pulmonary embolism. Eur Respir J 2003; 22: Suppl. 45, 3539

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