Key result
Early therapeutic anticoagulation (≤24 hours) was not associated with improved in-hospital mortality compared to delayed achievement in critically ill, obese PE patients (OR 1.33; 95% CI 0.647-2.72).
Why the study?
Delays in time to therapeutic aPTT have been linked to poor outcomes in acute PE, but the relationship between time to therapeutic anticoagulation and in-hospital mortality in critically ill, obese patients remained uncharacterized.
Does achieving therapeutic anticoagulation within 24 hours of UFH initiation reduce in-hospital mortality in critically ill, obese patients with acute pulmonary embolism?
Cohort (n=204)
Does achieving therapeutic anticoagulation within 24 hours of UFH initiation reduce in-hospital mortality in critically ill, obese patients with acute pulmonary embolism?
Odds Ratio: 1.33 (95% CI 0.647–2.72)
In critically ill, obese patients with acute pulmonary embolism, achieving therapeutic aPTT within 24 hours of unfractionated heparin initiation was not associated with improved survival compared to delayed achievement.
No association with mortality observed; leaves open optimal UFH dosing targets in obese critically ill PE.
Background: Delays in time to therapeutic activated partial thromboplastin time (aPTT) have been associated with poor outcomes in patients with acute pulmonary embolism (PE). Objective: To investigate the relationship between time to therapeutic anticoagulation and in-hospital mortality in critically ill, obese patients with acute PE. Methods: This study examined 204 critically ill patients with a body mass index (BMI) ≥30 kg/m 2 receiving unfractionated heparin (UFH) for PE treatment. Patients achieving therapeutic anticoagulation within 24 hours of UFH initiation (early) were compared to those in >24 hours (delayed). Additional end points included 30-day mortality, median time to therapeutic aPTT, proportion of therapeutic and supratherapeutic aPTT values, hemodynamic deterioration, thrombolytic therapy after UFH initiation, length of stay, and bleeding. Results: No difference in in-hospital or 30-day all-cause mortality was seen (odds ratio [OR]: 1.33, confidence interval [CI]: 0.647-2.72; OR: 1.003, CI: 0.514-1.96). Patients in the early group had a greater proportion of therapeutic aPTT values (66.7% vs 50%, P < .001) and higher percentage of supratherapeutic aPTT values (20.9% vs 11.3%, P < .001); however, no increase in clinically significant bleeding was evident (15.2% vs 10.9%, P = .366). Conclusion: In this population, a shorter time to therapeutic aPTT was not associated with improved survival.
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Sutton et al. (2019) conducted a cohort in Acute pulmonary embolism (n=204). Early therapeutic anticoagulation (≤24 hours) vs. Delayed therapeutic anticoagulation (>24 hours) was evaluated on In-hospital mortality (OR 1.33, 95% CI 0.647-2.72). Early therapeutic anticoagulation (≤24 hours) was not associated with improved in-hospital mortality compared to delayed achievement in critically ill, obese PE patients (OR 1.33; 95% CI 0.647-2.72).
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