E-Mail karger@karger.com www.karger.com/res Clinical Investigations Respiration 2013;86:318–323 DOI: 10.1159/000346203 Low-Molecular-Weight Heparin Use with Thrombolysis: Is it Effective and Safe? Ten Years’ Clinical Experience Elif Yilmazel Ucar Omer Araz Metin Akgun Mehmet Meral Fikriye Kalkan Leyla Saglam Hasan Kaynar Ali Metin Gorguner Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey curred in 3.7% (n = 4) and 0.7% (n = 2) and minor hemor- rhage in 12.1% (n = 13) and in 3.8% (n = 11) of the cases who received SC LMWH plus thrombolytics and SC LMWH, re- spectively. Conclusion: SC LMWH use with thrombolytics seems to be feasible and safe. Prospective, large, random- ized control trials are still required in order to confirm these results. Copyright © 2013 S. Karger AG, Basel Introduction Acute pulmonary embolism (PE) is a common and of- ten fatal disease, with an approximately 30% mortality rate without treatment [1]. Anticoagulation is the main- stay of the therapy for acute PE. It decreases the mortal- ity rate to 3–8%, when effective therapy is instituted as quickly as possible [2, 3]. In acute PE cases, therapeutic options include subcutaneous low-molecular-weight heparin (SC LMWH), intravenous unfractionated hepa- rin (IV UFH), subcutaneous unfractionated heparin and subcutaneous fondaparinux with or without thromboly- sis [3]. In the treatment of acute PE, SC LMWH is at least as effective and safe as IV UFH [4]. Compared to IV UFH, SC LMWH results in lower mortality, fewer recurrent Key Words Low-molecular-weight heparin · Thrombolysis · Acute pulmonary embolism Abstract Background: There is no data on the use of subcutaneous low-molecular-weight heparin (SC LMWH) in cases that re- quire thrombolysis. Objective: Having used SC LMWH with thrombolytics for more than 10 years, we aimed to review our data, share our experiences and find out whether the use of SC LMWH with thrombolytics had been effective and safe. Method: This is a retrospective cohort study. Patients who were diagnosed as acute pulmonary embolism (PE) and re- ceived either SC LMWH treatment or SC LMWH with throm- bolytics in our hospital (a tertiary hospital) between 2000 and 2010 were included in the study. For both treatments, the rates of mortality and complications were calculated. Re- sults: A total of 392 patients, 210 female (53.5%) and 182 male (46.5%) with an average age of 60 years, ±16 SD, with acute PE, were included in the study. Of these patients, 107 (27.2%) were massive and 285 (72.8%) were nonmassive and were administered SC LMWH plus thrombolytics and only SC LMWH, respectively. The mortality rate was 16.8% (18 of 107) in patients who were massive and 3.5% (10 of 285) for those who were nonmassive (p < 0.001). Major hemorrhage oc- Received: August 14, 2012 Accepted after revision: November 25, 2012 Published online: February 9, 2013 Dr. Elif Yilmazel Ucar Yakutiye Medical Research Center Chest Disease Department TR–25240 Yakutiye, Erzurum (Turkey) E-Mail eucar1979  @  yahoo.com © 2013 S. Karger AG, Basel 0025–7931/13/0864–0318$38.00/0