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Comparison of LMWH Versus UFH for Hemorrhage and Hospital Mortality in the Treatment of Acute Massive Pulmonary Thromboembolism After Thrombolytic Treatment

Randomized Controlled Parallel Group Study

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Abstract

Purpose

Current guidelines recommend the use of low molecular weight heparin (LMWH) for most haemodynamically stable patients with pulmonary thromboembolism (PTE), however, it is not clear whether LMWH is preferable to unfractionated heparin (UFH) for the treatment of massive PTE. We aimed to compare the use of LMWH versus UFH after thrombolytic treatment in the management of acute massive PTE for hemorrhage and hospital mortality.

Methods

The study, a randomized, single center, parallel design trial, included the patients who had confirmed the diagnosis of massive PTE according to clinical findings and computerized thorax angiography and no contraindication to the treatment between January 2011 and October 2013. After thrombolytic treatment, the patients assigned to therapy with LMWH or UFH. Any hemorrhage, major hemorrhage, and hospital mortality were assessed.

Results

A total of 121 patients, 71 female (58.7 %) and 50 male (41.3 %), who had massive PTE with an average age 62.6 ± 15.7 (ranges 22–87) were included for analyses in the study. They were allocated to either LMWH (n = 60) or UFH (n = 61) group. Although the occurrence of any adverse event (21.7 vs 27.9 %) and each individual type of adverse event were all lower in the LMWH group compared to UFH group (6.7 vs 11.5 %, 3.3 vs 9.8 %, and 15.0 vs 19.7 % for death, major hemorrhage, and any hemorrhage, respectively), the differences were not statistically significant.

Conclusions

Our findings suggest that LMWH might be a better option in the management of the patients with massive PTE. Multi-center larger randomized controlled trials are required to confirm our results.

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Acknowledgments

The authors acknowledge and thank the American Thoracic Society Methods in Epidemiologic, Clinical and Operations Research (MECOR) Program, and specifically the faculty of the ATS MECOR Global Course (William Vollmer and Cecilia M. Patino-Suttan), for their invaluable help in the development of our research skills and our love for research.

Conflict of interest

The authors declare that they have no conflict of interest in the publication of this article.

Author information

Authors and Affiliations

  1. Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Erzurum, Turkey

    Elif Yilmazel Ucar, Metin Akgun, Omer Araz, Bugra Kerget, Mehmet Meral, Hasan Kaynar & Leyla Saglam

  2. Department of Cardiology, Ataturk University School of Medicine, 25240, Erzurum, Turkey

    Hakan Tas

Authors
  1. Elif Yilmazel Ucar
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  2. Metin Akgun
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  3. Omer Araz
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  4. Hakan Tas
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  5. Bugra Kerget
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  6. Mehmet Meral
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  7. Hasan Kaynar
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  8. Leyla Saglam
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Corresponding author

Correspondence to Elif Yilmazel Ucar.

Additional information

This study has been submitted to ATS as an abstract, and also is a MECOR Global Project.

Clinical Trial Registration: www.clinicaltrials.gov (NCT01956955).

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Ucar, E.Y., Akgun, M., Araz, O. et al. Comparison of LMWH Versus UFH for Hemorrhage and Hospital Mortality in the Treatment of Acute Massive Pulmonary Thromboembolism After Thrombolytic Treatment. Lung 193, 121–127 (2015). https://doi.org/10.1007/s00408-014-9660-z

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  • DOI: https://doi.org/10.1007/s00408-014-9660-z

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