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Pulmonary Embolism Management: Unraveling Controve ...
Int Risk PE Discussion PE Precourse 24
Int Risk PE Discussion PE Precourse 24
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Pdf Summary
The document focuses on the treatment of intermediate-high risk pulmonary embolism (PE) and evaluates various interventions, particularly systemic thrombolysis (ST) and catheter-directed interventions (CDIs). Although ST shows no clear mortality benefit for intermediate-high-risk PE and carries a significant risk of major bleeding (notably 1 in 9 patients), its use remains low, applied in just 2.5% of all PE cases and 11% of high-risk cases. Mortality rates vary between 2.3-13.2%, with outcomes worsening following cardiopulmonary resuscitation (CPR).<br /><br />Catheter-directed interventions (CDIs) have gained interest as an alternative, especially for patients with contraindications to systemic fibrinolysis or those who do not respond to it. All current guidelines recommend CDIs as a rescue treatment, yet the lack of universal consensus stems from evidence gaps across international guidelines.<br /><br />Several clinical trials are detailed, evaluating various interventions for PE:<br /><br />1. **PEITHO 3 (RCT)** - Investigating half-dose systemic lysis versus anticoagulation (AC), assessing outcomes like death, hemodynamic collapse, and PE recurrence.<br /><br />2. **HI-PEITHO (RCT)** - Comparing catheter-directed lysis (CDL) using Ekos against AC, evaluating outcomes such as mortality, heart function, and quality of life (QOL).<br /><br />3. **PEERLESS (RCT)** - Contrasting CDL with suction thrombectomy using Flowtriever, examining mortality and clinical deterioration.<br /><br />4. **PEERLESS II (RCT)** - Suction thrombectomy using Flowtriever versus AC, assessing mortality, bleeding, and post-PE impairment.<br /><br />5. **STORM-PE (RCT)** and **STRIKE-PE (prospective cohort)** - Both focus on suction thrombectomy using Indigo and look at right ventricular to left ventricular (RV:LV) ratios, exercise capacity, and QOL.<br /><br />6. **PE-TRACT (RCT)** - Explores the efficacy of any catheter-directed thrombolysis (CDT) against AC, measuring cardiopulmonary exercise testing parameters.<br /><br />These studies aim to refine PE treatment protocols, considering both efficacy and safety concerning bleeding risks and long-term patient outcomes.
Keywords
pulmonary embolism
systemic thrombolysis
catheter-directed interventions
mortality
bleeding risk
PEITHO 3
HI-PEITHO
PEERLESS
suction thrombectomy
clinical trials
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