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Suboptimal management of unfractionated heparin compared with low‐molecular‐weight heparin in the management of pulmonary embolism
Author(s) -
Khor Y. H.,
Smith R.,
McDonald C. F.
Publication year - 2014
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12376
Subject(s) - medicine , partial thromboplastin time , pulmonary embolism , heparin , low molecular weight heparin , therapeutic index , activated clotting time , anesthesia , surgery , pharmacology , platelet , drug
Abstract Background Both low‐molecular‐weight heparin ( LMWH ) and unfractionated heparin ( UFH ) have been shown to be equivalent in efficacy and safety profiles for the management of pulmonary embolism ( PE ). Aims To assess the real world management of anticoagulation in PE in a tertiary hospital setting. Methods An audit of patients with a new diagnosis of PE from M arch 2011 to M arch 2012. Data collected included patient demographics, anticoagulant, complication, mortality, time to first administration, frequency of monitoring and dose adjustment for UFH , time to therapeutic range for UFH (based on activated partial thromboplastin time) and length of hospital stay. Results Of the 211 patients who were included, 139 were admitted through the E mergency D epartment, and 45 were managed with UFH . There was no significant difference in time to initial dose between those treated with LMWH and U FH (192 vs 98 min, P = 0.16). For UFH , average time to therapeutic range was 594 min (range 87–2257 min). During the course of UFH therapy, only 22% of activated partial thromboplastin time was within therapeutic range, while 44% was above and 33% was below therapeutic range. Average number of UFH dose adjustment was 5. Increasing weight and higher baseline fibrinogen levels significantly delayed time to therapeutic range for patients on UFH ( P = 0.02 and 0.04 respectively). Up to 18 months following PE , overall mortality rate was 28%, with no significant difference between LMWH and UFH (28% vs 29%). Conclusion PE was predominantly managed with LMWH . UFH was suboptimally managed when used, although there was no impact on mortality rate.