Objective To analyse the clinical effect of anticoagulant treatment in acute pulmonary embolism stratified as intermediate-risk.
Method Patients with intermediate-risk acute pulmonary embolism (PE) were enrolled in Center for Pulmonary Vascular Diseases, Fu Wai Hospital between Aug 2008 and Apr 2010. The intermediate-risk acute PE was defined as stable haemodynamics and the presence of right ventricular dysfunction (echocardiography or CT showed right ventricle dilation, pressure overload, BNP or NT-proBNP elevation) and/or markers of myocardial injury (stratified as intermediate-risk acute pulmonary embolism were included in this study. There were 29 men (42.6%) and 39 women (57.4%) with a mean age of 61.7±13.4 years. Right ventricle (RV) dilatation or pressure overload was present on echocardiography or CT in 49 cases (%), NT-proBNP elevation in 58 cases (%) and cardiac troponin I positive in 8 cases (%). The mean onset time was 15.7±18.0 days. The main complaints included dyspnoea (60 patients, 88.2%), chest pain (16 patinets, 23.5%), cough (16 patients, 23.5%), haemoptysis (8 patients, 11.8%), syncope (7 patients, 10.3%), palpitation (5 patients, 7.4%), dizziness (4 patients, 5.9%) and cyanosis (1 patient, 1.5%). Referring to ECG, 34 cases (50%) presented S1QIIITIII and 27 cases (39.7%) with T wave inversion in V1–V4 leads. The symptoms, physical signs and results of laboratory tests were improved significantly after anticoagulation by hemarin or low molecular weight heparin with a target INR of : heart rate (82.5±14.8 vs 69.9±7.5 beats/min, p<0.001) and D-dimer (5.8±4.7 mg/l vs 1.1±1.2 mg/l, p<0.001CTnT or CTnI) positive.
Results Sixty-eight patients significantly decreased; PaO2 (68.7±11.7 mm Hg vs 85.4±31.3 mm Hg, p<0.001), PCO2 (37.2±5.3 mm Hg vs 40.3±4.6 mm Hg, p<0.001) and SaO2 (93.5±3.4% vs 95.6±2.1%, p<0.001) significantly increased. During hospitalisation, ALT or AST was slightly increased in 12 cases (%) and became normal after regular treatment; Twelve patients had mild bleeding, including 4 cases with positive urine occult blood, 4 cases with slight conjunctival haemorrhage, 2 cases with slight haemoptysis and 1 case with positive fecal occult blood.
Conclusions Anticoagulant treatment to patients with acute pulmonary embolism stratified as intermediate-risk significantly improved the symptoms, physical signs and results of laboratory tests with slight and low occurrence rate of complications.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.