Administration of low-molecular-weight heparin resulted in 0 cases of pulmonary thromboembolism among 35 outpatients with heart failure and acute community acquired pneumonia.
Observational (n=35)
Does LMWH prevent pulmonary thromboembolism in outpatients with heart failure and acute community-acquired pneumonia?
Prophylactic and targeted therapeutic dosing of LMWH may prevent pulmonary thromboembolism in patients with heart failure and acute community-acquired pneumonia.
Abstract Acute pulmonary thromboembolism (PTE) is one of the serious complications in the patients with heart failure (HF) and acute community acquired pneumonia (CAP). Our purpose was prevention and timely diagnosis of PTE in patients with HF and CAP. All patients were monitored for signs of PE including D-dimer test, Wells score, coagulation tests and echocardiography (EC). CT pulmonary angiography (CTPA) was done in high-risk cases. We observed 35 outpatients with HF and CAP (20 women, 15 men). Age was ranged between 41 - 75 years. All these P had also arterial hypertension well controlled by hypotensive medications. HF with preserved EF was observed in 18P, HF with mildly reduced EF – in 12P, HF with reduced EF – in 5P. Neither of these P had atrial fibrillation, acute myocardial infarction or malignancy. Among these 35 P 20 P were receiving aspirin 100mg/day more than a month prior CAP. Among 35 patients in coagulation tests INR was at the low level of normal range in 21 P, in the rest 14 it was 0,9; In all P APPT was in normal range, while fibrinogen(F) was increased in all P. In 8 P it was 4g/L, but less than 5g/L, in 18 P it was between 5-7,5g/L, 9 P had F 7,5g/L. In all patients D-dimer was 500 µg/L, in 16 of them it was 1200 µg/L, in 12 P it was between 1250-2000 µg/L, in 7P D-dimer was 2050µg/L. Notable that among the last 7P 4 had deep vein thrombosis (DVT) in anamnesis. All patients with HF and CAP from the beginning was prescribed low-molecular-weight heparin (LMWH) at prophylaxis dosage of 0,4ml/day. P with increased D-dimer above 1200 µg/L and/or fibrinogen 7,5g/L was done CTPA. Neither of them was reveled PTE, but these P continued treatment with LMWH at therapeutic dosage 0,8-1,2 ml/day according to D-dimer and F levels for 10 -12 days. Use of LMWH prevented development of PTE in the patients with HF and CAP. In conclusion vigilant monitoring of patients with HF and CAP investigating coagulation tests, D-dimer test, EC and CTPA reveals high-risk P for the development of PTE. Timely treatment of these P with appropriate dosages of LMWH will prevent development of such sever complication as PTE in them.
Saralidze et al. (Mon,) conducted a observational in Heart failure and acute community acquired pneumonia (n=35). Low-molecular-weight heparin (LMWH) was evaluated on Pulmonary thromboembolism (PTE). Administration of low-molecular-weight heparin resulted in 0 cases of pulmonary thromboembolism among 35 outpatients with heart failure and acute community acquired pneumonia.