How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey

Taslakian, Bedros; Li, Clayton; Goldhaber, Samuel Z.; Mikkelsen, Kathryn Z; Horowitz, James; Kabrhel, Christopher; Barnes, Geoffrey D.; Sista, Akhilesh K.

doi:10.3390/jcm8020215

Cited by 2 publications

(1 citation statement)

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“…In conclusion, although CDT seems effective on reducing RV load in the acute phase and the bleeding risk is lower compared with ST, evidence regarding its long-term outcomes and effect on mortality is so far absent 30 . Interestingly, a recent survey on clinical decision-making between either CDT or anticoagulation alone in patients with intermediate-risk PE showed that patients are willing to accept a higher risk of bleeding than physicians if it would improve their long-term exercise capacity 31 . This further underlines the importance of studies including assessment of long-term functional outcomes.…”

Section: Catheter-based Therapies In Intermediate-risk Pulmonary Embomentioning

confidence: 99%

Rationale for catheter-based therapies in acute pulmonary embolism

Winter

Vlachojannis

Ruigrok

et al. 2019

European Heart Journal Supplements

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Pulmonary embolism (PE) is a common disease resulting in significant morbidity and mortality. High-risk features of PE are hypotension or shock, and early reperfusion is warranted to unload the strained right ventricle and improve clinical outcomes. Currently, systemic thrombolysis (ST) is the standard of care but is associated with bleeding complications. Catheter-based therapies (CDT) have emerged as a promising alternative having demonstrated to be equally effective while having a lower risk of bleeding. Several CDT are currently available, some combining mechanical properties with low-dose thrombolytics. Recent guidelines suggest that CDT may be considered in patients with high-risk PE who have high bleeding risk, after failed ST, or in patients with rapid haemodynamic deterioration as bail-out before ST can be effective, depending on local availability and expertise. In haemodynamically stable patients with right ventricular (RV) dysfunction (intermediate-risk PE), CDT may be considered if clinical deterioration occurs after starting anticoagulation and relative contraindications for ST due to bleeding risk exist. Decision on treatment modality should follow a risk-benefit analysis on a case by case base, weighing the risk of PE-related complications; i.e. haemodynamic deterioration vs. bleeding. As timely initiation of treatment is warranted to prevent early mortality, bleeding risk factors should be assessed at an early stage in all patients with acute PE and signs of RV dysfunction. To ensure optimal management of complex cases of PE and assess a potential CDT strategy, a multidisciplinary approach is recommended. A dedicated Pulmonary Embolism Response Team may optimize this process.

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Section: Catheter-based Therapies In Intermediate-risk Pulmonary Embomentioning

confidence: 99%