PMID- 31625654
OWN - NLM
STAT- MEDLINE
DCOM- 20200515
LR  - 20200515
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Linking)
VI  - 27
IP  - 2
DP  - 2020 Feb
TI  - Analysis of Partial Thromboplastin Times in Patients With Pulmonary Embolism 
      During the First 48 Hours of Anticoagulation With Unfractionated Heparin.
PG  - 117-127
LID - 10.1111/acem.13872 [doi]
AB  - OBJECTIVE: The objective was to determine the proportion of patients with 
      pulmonary embolism (PE) treated with unfractionated heparin (UFH) who achieved 
      therapeutic activated partial thromboplastin time (aPTT) values within 48 hours 
      of treatment. METHODS: Retrospective analysis of a PE response team (PERT) 
      database was performed at a large, urban, academic teaching hospital. Inclusion 
      criteria were adult patients with acute PE for whom the PERT was consulted and 
      who received anticoagulation (AC) with UFH according to guideline standard 
      dosing. aPTT values during 6-hour time periods during the first 48 hours of AC 
      were collected and analyzed. RESULTS: A total of 505 patients met inclusion 
      criteria. For patients receiving a bolus and infusion of UFH, the proportions 
      (95% confidence interval [CI]) of patients in the therapeutic range were 19.0% 
      (14.2% to 25.0%) at 12 hours, 26.3% (26.3% to 33.1%) at 24 hours, 28.3% (22.0% to 
      35.4%) at 36 hours, and 28.4% (20.8% to 37.5%) at 48 hours. For titrated infusion 
      only, the proportions (95% CIs) of patients were 23.3% (16.2% to 32.3%) at 
      12 hours, 41.4% (31.6% to 51.9%) at 24 hours, 37.0% (26.8% to 48.5%) at 36 hours, 
      and 42.1% (30.2% to 55.0%) at 48 hours. No patient had all therapeutic aPTT 
      values. CONCLUSIONS: The majority of patients with acute PE spend most of their 
      first 48 hours outside of the therapeutic range of AC when treated with guideline 
      standard dosing of UFH. Over half of the patients fail to achieve any therapeutic 
      PTT level within 24 hours of UFH initiation, and no patient had all therapeutic 
      aPTTs. Future research should focus on identifying factors associated with 
      achieving therapeutic AC with UFH.
CI  - (c) 2019 by the Society for Academic Emergency Medicine.
FAU - Prucnal, Christiana K
AU  - Prucnal CK
AD  - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts 
      General Hospital, Boston, MA.
FAU - Jansson, Paul S
AU  - Jansson PS
AUID- ORCID: 0000-0002-9230-3249
AD  - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts 
      General Hospital, Boston, MA.
AD  - Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
AD  - Department of Emergency Medicine, Harvard Medical School, Boston, MA.
FAU - Deadmon, Erin
AU  - Deadmon E
AD  - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts 
      General Hospital, Boston, MA.
FAU - Rosovsky, Rachel P
AU  - Rosovsky RP
AD  - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts 
      General Hospital, Boston, MA.
AD  - Division of Hematology, Department of Medicine, Massachusetts General Hospital, 
      Boston, MA.
FAU - Zheng, Hui
AU  - Zheng H
AD  - Biostatistics Center, Massachusetts General Hospital, Boston, MA.
AD  - Department of Medicine, Harvard Medical School, Boston, MA.
FAU - Kabrhel, Christopher
AU  - Kabrhel C
AD  - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts 
      General Hospital, Boston, MA.
AD  - Department of Emergency Medicine, Harvard Medical School, Boston, MA.
LA  - eng
GR  - Centers of Expertise in Healthcare Quality and Pat/Partners 
      Healthcare/International
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20191124
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Acad Emerg Med. 2020 Feb;27(2):176-178. PMID: 31625222
MH  - Acute Disease
MH  - Adult
MH  - Anticoagulants/*administration & dosage
MH  - Drug Administration Schedule
MH  - Female
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Partial Thromboplastin Time/*statistics & numerical data
MH  - Pulmonary Embolism/*drug therapy
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2019/10/19 06:00
MHDA- 2020/05/16 06:00
CRDT- 2019/10/19 06:00
PHST- 2019/04/22 00:00 [received]
PHST- 2019/06/26 00:00 [revised]
PHST- 2019/08/08 00:00 [accepted]
PHST- 2019/10/19 06:00 [pubmed]
PHST- 2020/05/16 06:00 [medline]
PHST- 2019/10/19 06:00 [entrez]
AID - 10.1111/acem.13872 [doi]
PST - ppublish
SO  - Acad Emerg Med. 2020 Feb;27(2):117-127. doi: 10.1111/acem.13872. Epub 2019 Nov 
      24.