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Published on: September 6, 2024
Delayed anticoagulation is associated with poor outcomes in high-risk acute pulmonary embolism
Sarah Soh1, Jeong Min Kim1, Jin Ha Park1
1Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Insights
Early anticoagulation is crucial for high-risk pulmonary embolism (PE) patients. Delayed treatment initiation in the intensive care unit (ICU) is linked to increased in-hospital mortality, highlighting the importance of timely intervention.
Area of Science:
- Critical Care Medicine
- Cardiology
- Pulmonary Medicine
Background:
- Pulmonary embolism (PE) requires prompt diagnosis and treatment for optimal patient outcomes.
- The impact of anticoagulation timing on clinical outcomes in high-risk acute PE patients remains understudied.
- Early intervention is critical in managing severe cases of PE.
Purpose of the Study:
- To investigate the relationship between the timing of anticoagulation initiation and in-hospital mortality in high-risk acute PE patients.
- To analyze the prognostic significance of early anticoagulation in the intensive care unit (ICU) setting.
Main Methods:
- A retrospective study included 73 high-risk acute PE patients admitted to a teaching hospital's ICU.
- Data collected included demographics, clinical status, radiological findings, and treatment details.
- Analysis focused on the time from hospital arrival to anticoagulation initiation and time to therapeutic anticoagulation levels.
Main Results:
- Survivors had a significantly shorter median time from hospital arrival to anticoagulation initiation (3.6 hours) compared to nonsurvivors (5.7 hours).
- The time to achieve a therapeutic anticoagulation level was similar between survivors and nonsurvivors.
- Ventilatory support and vasopressor use were associated with increased in-hospital mortality.
Conclusions:
- Delayed anticoagulation is a significant prognostic factor for adverse outcomes in high-risk acute PE patients.
- Timely initiation of anticoagulation therapy is essential for improving survival rates in critically ill PE patients.
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.
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