January 1, 1997Thrombosis and Haemostasis
Effects of Heparin Therapy on Fibrinolysis in Patients with Pulmonary Embolism
Why the study?
Does therapeutic heparinization enhance fibrinolysis in patients suspected of pulmonary embolism?
Population
49 consecutive patients suspected of pulmonary embolism (PE); 28 had confirmed PE, 21 had PE excluded.
Comparison
Therapeutic levels of heparinization (heparin) vs Baseline (pre-heparinization) levels
Design
Cohort
Authors
Discussion
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Implication
Questions assumption of heparin-enhanced fibrinolysis in suspected PE; leaves open outcome implications in this Level 3 cohort.
Key Points
- To determine whether therapeutic heparin administration induces endogenous fibrinolysis in patients presenting with suspected pulmonary embolism.
- Obtained blood samples from 49 consecutive patients with suspected pulmonary embolism, including 28 with confirmed pulmonary embolism and 21 in whom pulmonary embolism was excluded.
- Measured plasma concentrations of tissue-type plasminogen activator (tPA), plasmin-alpha 2antiplasmin complexes, and D-dimer before and after therapeutic heparinization.
- Baseline plasma levels of plasmin-alpha 2antiplasmin complexes and D-dimer were significantly higher in patients with confirmed pulmonary embolism than in those without.
- Heparin therapy induced an increase in tPA antigen levels across both confirmed and excluded groups, independent of baseline fibrinolytic activity.
- Despite the elevation in tPA levels, concentrations of plasmin-alpha 2antiplasmin complexes and D-dimer decreased following heparin administration.
Structured PICO
Does therapeutic heparinization enhance fibrinolysis in patients suspected of pulmonary embolism?
P
Population
49 consecutive patients suspected of pulmonary embolism (PE); 28 had confirmed PE, 21 had PE excluded.
I
Intervention
Therapeutic levels of heparinization (heparin)
C
Comparator
Baseline (pre-heparinization) levels
O
Outcome
Plasma markers for fibrinolysis (tissue type plasminogen activator [tPA] levels, plasmin-alpha 2antiplasmin complexes, and D-dimer)surrogate
Therapeutic heparinization increases tPA levels in patients suspected of pulmonary embolism but does not lead to enhanced fibrinolysis.
Cite This Study
Minnema et al. (1997) studied this question.