JVIR twitter

Friday, May 1, 2020

Safety of Therapeutic Anticoagulation with Low-Molecular-Weight Heparin or Unfractionated Heparin Infusion during Catheter-Directed Thrombolysis for Acute Pulmonary Embolism


Clinical question
Is there a significant difference in complication profile in use of therapeutic dosed low-molecular-weight heparin versus unfractionated heparin infusion during catheter directed thrombolysis?

Take-away point
No significant difference was found in complication rates between use of therapeutic dosed low-molecular-weight heparin and heparin infusion during catheter directed thrombolysis for acute pulmonary embolism

Reference
Assaf Graif et al. Safety of Therapeutic Anticoagulation with Low-Molecular-Weight Heparin or Unfractionated Heparin Infusion during Catheter-Directed Thrombolysis for Acute Pulmonary Embolism. Journal of Vascular and Interventional Radiology. April, 2020: 31; 4, 537-543.

Click here for abstract

Study design
Retrospective Review

Funding source
Self-funded or unfunded

Setting
Single-center


Figure 3. Complications

Summary


Anticoagulation dosing during catheter directed thrombolysis for pulmonary embolism (PE) remains controversial with no clear consensus between cessation of systemic anticoagulation versus therapeutic dosing versus subtherapeutic dosing. Similarly, there is no clear data to differentiate use of low-molecular-weight heparin (LMWH) versus unfractionated heparin. This study aimed to evaluate safety of therapeutic-dose anticoagulation. With a focus on hemorrhagic complications, during catheter directed thrombolysis for acute pulmonary embolism.

156 patients were identified who underwent catheter directed thrombolysis for submassive of massive acute pulmonary embolism. All patients were treated with therapeutic anticoagulation, either unfractionated heparin infusion (ptt every 6 hours with target range of 50-80 seconds) or LMWH (weight based, BID 1 mg/kg) based on physician preference. Primary endpoints were hemorrhagic complications and all complications. No significant difference in hemorrhagic complication or all complications was found between heparin infusion and LMWH groups.

Commentary


Based on this study, there does not appear to be a significant difference in complication rate between therapeutic LMWH and heparin infusion during catheter directed thrombolysis for acute pulmonary embolism. The authors compared their complication rates to those of other studies using sub-therapeutic anticoagulation without major differences. While this may suggest no increased complication rate with use of therapeutic dosing, it does not prove any benefit either.

As is often the difficulty in retrospective reviews, there is significant heterogeneity in treatments performed. While the paper focused on heparin infusion versus LMWH, there was also significant variability in the catheter directed thrombolysis procedures (unilateral versus bilateral, infusion catheter choice, clot fragmentation, thrombectomy, plasty). Additionally, 5% of patients received systemic tPA prior to thrombolysis.

Further research is necessary in this realm, specifically comparing therapeutic dosing to subtherapeutic dosing of anticoagulation while minimizing heterogeneity between treatments.

Post Author
David M Mauro, MD
Assistant Professor
Department of Radiology, Vascular and Interventional Radiology
University of North Carolina

@DavidMauroMD

1 comment:

  1. Am Laura Mildred by name, i was diagnosed with Herpes 4 years ago i lived in pain with the knowledge that i wasn't going to ever be well again i contacted so many herbal doctors on this issue and wasted a large sum of money but my condition never got better i was determined to get my life back so one day i saw Mr. Morrison Hansen post on how Dr. Emu saved him from Herpes with herbal medicine i contacted Dr. Emu on his Email: Emutemple@gmail.com we spoke on the issue i told him all that i went through and he told me not to worry that everything will be fine again so he prepared the medicine and send it to me and told me how to use it, after 14 days of usage I went to see the doctor for test,then the result was negative, am the happiest woman on earth now thanks to Dr. Emu God bless you. Email him at: Emutemple@gmail.com Whats-app or Call him +2347012841542 

    ReplyDelete