Anticoagulation as Adjunctive Treatment and One-Hour Alteplase Infusion


Fibrinolytic regimen evaluation

Variable

Pre n = 40 (%)

Post n = 40 (%)

p

Right ventricular sound

96

5

<0.0001

Shock

15

0

<0.0001

Respiratory rate

33.5 ± 5.7

25.0 ± 4.4

<0.0001

Cardiac rate

108.9 ± 13.1

94.4 ± 8.9

0.008

Systolic pressure

102.3 ± 19.7

119.5 ± 10

<0.001

Diastolic pressure

61.2 19.6

76.7 ± 8.4

<0.001

Oximetry

84.7 ± 4.3

95.5 ± 3.1

<0.001

Echocardiogram

PA systolic pressure

62.3 ± 12.4

38.26 ± 12.4

<0.001

RV diastolic diameter

43.9 ± 4.4

32.30 ± 4.8

<0.001

RV hypokinesis

75

18

0.007

McConnell sign

48

8

0.005

V/Q lung scan (32 patients)

Perfusion defects

10.7 ± 1.7

6.07 ± 3.1

<0.001

Unfractionated heparin evaluation

Variable

Pre

Post

p

Right ventricular sound

95

95

1

Shock

18

18

1

Respiratory rate

37.5 ± 3.4

38.0 ± 5.6

0.63

Cardiac rate

116.0 ± 10.2

111.0 ± 9.1

0.02

Systolic pressure

103.5 ± 18.5

95 ± 20.4

0.05

Oximetry

83.5 ± 3.6

81.7 ± 5.8

0.06

Echocardiogram

PA systolic pressure

58.4 ± 1.8

56.2 ± 3.6

0.0009

RV diastolic diameter

41.0 ± 2.9

44.0 ± 4.9

0.001

RV hypokinesis

90

90

1

McConnell sign

43

40

95

V/Q lung scan (32 patients)

Perfusion defects

10.5 ± 1.8

7.0 ± 2.84

0.001


Modified from: Jerjes-Sanchez C, et al. J Thromb Thrombolysis 2009; 27:154–162

PA pulmonary artery, RV right ventricular



In-hospital clinical course and adverse events: Findings regarding major adverse cardiovascular events, escalation treatment, in-hospital stay, and bleeding complications are presented in Table 5.2. Patients under thrombolysis had better outcome than patients under unfractionated heparin alone. Major bleeding complications had a close relationship with venous puncture in both groups [10].


Table 5.2
In-hospital outcome, follow-up, and adverse events














































































































































































































Variable

Alteplase 1 h + enoxaparin n = 40 (%)

UH n = 40 (%)

p

Mortality

3

25

0.009

Recurrence

10

20

0.17

Escalation treatment

3

53

<0.001

In-hospital stay (days)

6.7 ± 1.7

16.4 ± 8.7

<0.001

Rescue thrombolysis

10

0

0.12

Bleeding (total)

13

13

1

Major hemorrhage

8

8

1

Groin hematoma

5

3

0.78

Jugular hematoma

3

5

0.78

Intracranial hematoma

0

0


Minor hemorrhage

5

5

1

Cava filter

3

43

<0.001

Pulmonary percutaneous intervention

5

0

0.47

Follow-up and adverse events

30 days
     

Patients

39

30
 

Mortality

0

3

0.89

Recurrence PE

0

3

0.06

DVT

0

7

0.36

Bleeding

0

0


Perfusion defects

3.4 ± 2.0

5.2 ± 1.6

<0.001

Normal echocardiogram

90

87

0.98

90 days
     

Patients

39

29
 

Mortality

0

7

0.34

Recurrence PE

3

7

0.79

DVT

0

7

0.34

Bleeding

0

0


Perfusion defects

2.8 ± 2.1

4.6 ± 1.5

<0.001

Normal echocardiogram

95

82

0.22

180 days
     

Patients

39

27
 

Mortality

0

7

0.34

Recurrence PE

0

22

0.007

DVT

0

26

0.003

Bleeding

0

0


Normal echocardiogram

97

55

0.01

Patients

40

40
 

Global mortality

3

38

0.0002


Modified from: Jerjes-Sanchez C, et al. J Thromb Thrombolysis 2009; 27:154–162

DVT deep venous thrombosis

Follow-up and major adverse cardiovascular events: Follow-up was complete in 100 % of the cases (Table 5.2). Within the first 30 and 90 days the most important clinical finding was a pulmonary perfusion improvement in alteplase plus enoxaparin group compared with unfractionated heparin alone. Although a trend to major incidence of major adverse cardiovascular events in unfractionated heparin group was observed, these clinical findings had statistical significance until day 180, including a better right ventricular remodeling. Global mortality was another relevant clinical finding (Table 5.2) [10].

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May 9, 2017 | Posted by in CRITICAL CARE | Comments Off on Anticoagulation as Adjunctive Treatment and One-Hour Alteplase Infusion

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