Delayed anticoagulation is associated with poor outcomes in high-risk acute pulmonary embolism
Delayed anticoagulation is associated with poor outcomes in high-risk acute pulmonary embolism
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DOI：
10.1016/j.jcrc.2015.11.024
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发表时间：
2016-04-01
影响因子：
3.7
通讯作者：
Na, Sungwon
中科院分区：
文献类型：
--
作者：
Soh, Sarah;Kim, Jeong Min;Na, Sungwon
目的：早期诊断和及时治疗是改善肺栓塞（PE）预后的关键，但尚未有研究探讨抗凝时间对高危急性PE患者临床预后的影响。我们分析了某教学医院重症监护病房（ICU）高危急性PE患者早期抗凝治疗与住院死亡率的关系。材料与方法：本回顾性研究纳入ICU收治的73例PE患者。收集患者入院时的人口学、临床、放射学和治疗资料，并分析诊断时间和抗凝起始时间。结果：存活患者67例。幸存者从到达医院到开始抗凝治疗的中位时间（3.6[2.6-5.0]小时）明显低于非幸存者（5.7[4.5-14.9]小时；P = .03）。然而，达到治疗性抗凝水平所需的中位时间在幸存者和非幸存者之间是相当的（12.0 [9.5-19.5]vs 16.4[10.7-27.4]小时；P = .488）。通气支持和血管加压剂的使用与较高的住院死亡率相关。结论：延迟抗凝治疗是高危急性PE患者预后不良的重要因素。(C) 2015爱思唯尔公司版权所有。
Purpose: Early diagnosis and timely treatment are essential to improve the outcomes of pulmonary embolism (PE), but no study has investigated the impact of anticoagulation timing on clinical outcomes in high-risk acute PE patients. We analyzed the relationship between early anticoagulation initiation and in-hospital mortality in high-risk acute PE patients at the intensive care unit (ICU) of a teaching hospital.Materials and methods: Seventy-three PE patients admitted to the ICU were included in this retrospective study. Demographic, clinical, radiological, and therapeutic data were collected on ICU admission, and the timings of diagnosis and anticoagulation initiation were analyzed.Results: The number of survivors was 67. The median time from hospital arrival to the start of anticoagulation therapy was significantly lower in survivors (3.6 [2.6-5.0] hours) than nonsurvivors (5.7 [4.5-14.9] hours; P = .03). However, the median time required to achieve a therapeutic anticoagulation level was comparable between survivors and nonsurvivors (12.0 [9.5-19.5] vs 16.4 [10.7-27.4] hours; P = .488). Ventilatory support and vasopressor use were found to be associated with higher in-hospital mortality.Conclusions: Delayed anticoagulation is an important prognostic factor of poor outcomes in high-risk acute PE patients. (C) 2015 Elsevier Inc. All rights reserved.