Experience in the treatment of patients with pulmonary embolism using apixaban and ultrasound inhalations of unfractionated heparin

Abstract

Introduction. Pulmonary embolism (PE) is one of the leading causes of death even in hospitalized patients. The standard treatment results are disappointing. Since 2004, we have tested a new method for the treatment of hemodynamically insignificant PE (own patent RU2224525C1) by using unfractionated heparin (UFH) in ultrasound inhalations with a nebulizer, since 2014 – in combination with apixaban. Aim. To improve the treatment of PE. Materials and methods. The hospital mortality rate of 713 patients of the cardiac intensive care unit with hemodynamically insignificant PE (from January 1, 2002 to December 31, 2017) was studied. Since 2004, patients have received ultrasound UFH (5000 units twice a day). Since 2014, nebulased UFH has been supplemented with the use of apixaban (10 mg twice a day for 7 days and 5 mg twice a day thereafter). Results and discussion. There is a distinct tendency to the PE hospital mortality decrease, coinciding with the nebulased UFH use (illustrated by a diagram). Neither the systemic bleeding nor the heparin-induced thrombocytopenia were observed. Clinical cases show first reduction of perfusion disorders are seeing scintigraphicaly in 7 days. Unlike LMWH UFH is recommended in severe kidney damage and obesity, thus ultrasound technique has advantages in such patients. Conclusions. Nebulased UFH is an available, simple, safe and effective in treatmtnt of hemodynamically insignificant PE, especially with the use of apixaban. A real improvement in lung perfusion takes 1 week, as shown scintigraphically.