Treating acute pulmonary embolism with anticoagulant therapy (Guideline) - PulmCCM
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Apr 092012
 

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  7 Responses to “Treating acute pulmonary embolism with anticoagulant therapy (Guideline)”

  1. The above statements regarding lovenox dosing appear to suggest we use a 2 mg/kg once a day dose versus the APPROVED dose of 1.5 mg/kg once a day. The CHEST guidelines reference APPROVED dosing of LMWH where the total once a day dose is equivalent to the bid total daily dose. Unfortunately, this language may cause over dosing errors with once a day lovenox. Lovenox 2mg/kg once daily has never been studied in RCTs and should not be advocated (per the manufacturer clinical experts).

    • Mike: Thanks for making this very important point. I revised that section of the post (above) to draw attention to this question and I’ve also emailed Elie Akl, the corresponding author to ask for clarification. -Matt

  2. Is there ever any differentiation between LMWH and IV unfractionated heparin? A common regional practice is to use IV UFH for “large” pulmonary clots. Am I correct that this distinction is not made in the guidelines and, if anything, LMWH is actually preferred unless the patient may be a thrombolytic candidate?

  3. Is there any evidence to treat with subcutaneus unfractionated heparin for acute PE?

  4. can anyone clarify the following?

    1) When is unfractionated Heparin preferred over LMWH ?

    2) What is the difference of efficacy in Unfractionated Heparin and LMWH in Massive PE? Any clinical trial comparing this?

  5. What happens if there is a patient with previous dvt or pe that is being treated with coumadin. They have been therapeutic but become subtherapeutic. Is it necessary to bridge these patients?

  6. No I dont think so , I had a patient who had no access whatso ever and we decided to give him big doses of S/Q UFH and recheck PTT in 2-3 hrs after the dose and then come up with a dosing protocol for that , never were able to figure out what is the correct dose for that, he died from CRI and ESRD complications

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