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• W4291020925 abstract "Background Acute pulmonary embolism (APE) is a major cause of acute morbidity and mortality. APE results in long‐term morbidity in up to 50% of survivors, known as post‐pulmonary embolism (post‐PE) syndrome. APE can be classified according to the short‐term (30‐day) risk of mortality, based on a variety of clinical, imaging and laboratory findings. Most mortality and morbidity is concentrated in high‐risk (massive) and intermediate‐risk (submassive) APE. The first‐line treatment for APE is systemic anticoagulation. High‐risk (massive) APE accounts for less than 10% of APE cases and is a life‐threatening medical emergency, requiring immediate reperfusion treatment to prevent death. Systemic thrombolysis is the recommended treatment for high‐risk (massive) APE. However, only a minority of the people affected receive systemic thrombolysis, due to comorbidities or the 10% risk of major haemorrhagic side effects. Of those who do receive systemic thrombolysis, 8% do not respond in a timely manner. Surgical pulmonary embolectomy is an alternative reperfusion treatment, but is not widely available. Intermediate‐risk (submassive) APE represents 45% to 65% of APE cases, with a short‐term mortality rate of around 3%. Systemic thrombolysis is not recommended for this group, as major haemorrhagic complications outweigh the benefit. However, the people at higher risk within this group have a short‐term mortality of around 12%, suggesting that anticoagulation alone is not an adequate treatment. Identification and more aggressive treatment of people at intermediate to high risk, who have a more favourable risk profile for reperfusion treatments, could reduce short‐term mortality and potentially reduce post‐PE syndrome. Catheter‐directed treatments (catheter‐directed thrombolysis and catheter embolectomy) are minimally invasive reperfusion treatments for high‐ and intermediate‐risk APE. Catheter‐directed treatments can be used either as the primary treatment or as salvage treatment after failure of systemic thrombolysis. Catheter‐directed thrombolysis administers 10% to 20% of the systemic thrombolysis dose directly into the thrombus in the lungs, potentially reducing the risks of haemorrhagic side effects. Catheter embolectomy mechanically removes the thrombus without the need for thrombolysis, and may be useful for people with contraindications for thrombolysis. Currently, the benefits of catheter‐based APE treatments compared with existing medical and surgical treatment are unclear despite increasing adoption of catheter treatments by PE response teams. This review examines the evidence for the use of catheter‐directed treatments in high‐ and intermediate‐risk APE. This evidence could help guide the optimal treatment strategy for people affected by this common and life‐threatening condition. Objectives To assess the effects of catheter‐directed therapies versus alternative treatments for high‐risk (massive) and intermediate‐risk (submassive) APE. Search methods We used standard, extensive Cochrane search methods. The latest search was 15 March 2022. Selection criteria We included randomised controlled trials (RCTs) of catheter‐directed therapies for the treatment of high‐risk (massive) and intermediate‐risk (submassive) APE. We excluded catheter‐directed treatments for non‐PE. We applied no restrictions on participant age or on the date, language or publication status of RCTs. Data collection and analysis We used standard Cochrane methods. The main outcomes were all‐cause mortality, treatment‐associated major and minor haemorrhage rates based on two established clinical definitions, recurrent APE requiring retreatment or change to a different APE treatment, length of hospital stay, and quality of life. We used GRADE to assess certainty of evidence for each outcome. Main results We identified one RCT (59 participants) of (ultrasound‐augmented) catheter‐directed thrombolysis for intermediate‐risk (submassive) APE. We found no trials of any catheter‐directed treatments (thrombectomy or thrombolysis) in people with high‐risk (massive) APE or of catheter‐based embolectomy in people with intermediate‐risk (submassive) APE. The included trial compared ultrasound‐augmented catheter‐directed thrombolysis with alteplase and systemic heparinisation versus systemic heparinisation alone. In the treatment group, each participant received an infusion of alteplase 10 mg or 20 mg over 15 hours. We identified a high risk of selection and performance bias, low risk of detection and reporting bias, and unclear risk of attrition and other bias. Certainty of evidence was very low because of risk of bias and imprecision. By 90 days, there was no clear difference in all‐cause mortality between the treatment group and control group. A single death occurred in the control group at 20 days after randomisation, but it was unrelated to the treatment or to APE (odds ratio (OR) 0.31, 95% confidence interval (CI) 0.01 to 7.96; 59 participants). By 90 days, there were no episodes of treatment‐associated major haemorrhage in either the treatment or control group. There was no clear difference in treatment‐associated minor haemorrhage between the treatment and control group by 90 days (OR 3.11, 95% CI 0.30 to 31.79; 59 participants). By 90 days, there were no episodes of recurrent APE requiring retreatment or change to a different APE treatment in the treatment or control group. There was no clear difference in the length of mean total hospital stay between the treatment and control groups. Mean stay was 8.9 (standard deviation (SD) 3.4) days in the treatment group versus 8.6 (SD 3.9) days in the control group (mean difference 0.30, 95% CI −1.57 to 2.17; 59 participants). The included trial did not investigate quality of life measures. Authors' conclusions There is a lack of evidence to support widespread adoption of catheter‐based interventional therapies for APE. We identified one small trial showing no clear differences between ultrasound‐augmented catheter‐directed thrombolysis with alteplase plus systemic heparinisation versus systemic heparinisation alone in all‐cause mortality, major and minor haemorrhage rates, recurrent APE and length of hospital stay. Quality of life was not assessed. Multiple small retrospective case series, prospective patient registries and single‐arm studies suggest potential benefits of catheter‐based treatments, but they provide insufficient evidence to recommend this approach over other evidence‐based treatments. Researchers should consider clinically relevant primary outcomes (e.g. mortality and exercise tolerance), rather than surrogate markers (e.g. right ventricular to left ventricular (RV:LV) ratio or thrombus burden), which have limited clinical utility. Trials must include a control group to determine if the effects are specific to the treatment." @default.
• W4291020925 created "2022-08-13" @default.
• W4291020925 creator A5064213983 @default.
• W4291020925 creator A5068814270 @default.
• W4291020925 creator A5069409270 @default.
• W4291020925 date "2022-08-08" @default.
• W4291020925 modified "2023-10-16" @default.
• W4291020925 title "Catheter-directed therapies for the treatment of high risk (massive) and intermediate risk (submassive) acute pulmonary embolism" @default.
• W4291020925 cites W1141106418 @default.
• W4291020925 cites W1247968195 @default.
• W4291020925 cites W1981680557 @default.
• W4291020925 cites W1987942247 @default.
• W4291020925 cites W2002821499 @default.
• W4291020925 cites W2005231266 @default.
• W4291020925 cites W2009326492 @default.
• W4291020925 cites W2011351675 @default.
• W4291020925 cites W2011611174 @default.
• W4291020925 cites W2013764507 @default.
• W4291020925 cites W2015077204 @default.
• W4291020925 cites W2015392265 @default.
• W4291020925 cites W2018856451 @default.
• W4291020925 cites W2047226579 @default.
• W4291020925 cites W2058979696 @default.
• W4291020925 cites W2066754704 @default.
• W4291020925 cites W2071602068 @default.
• W4291020925 cites W2075776825 @default.
• W4291020925 cites W2090132603 @default.
• W4291020925 cites W2093043874 @default.
• W4291020925 cites W2105077761 @default.
• W4291020925 cites W2107941853 @default.
• W4291020925 cites W2109346853 @default.
• W4291020925 cites W2110112924 @default.
• W4291020925 cites W2116562602 @default.
• W4291020925 cites W2120203545 @default.
• W4291020925 cites W2122779695 @default.
• W4291020925 cites W2123852718 @default.
• W4291020925 cites W2127150045 @default.
• W4291020925 cites W2133473187 @default.
• W4291020925 cites W2145404820 @default.
• W4291020925 cites W2159007980 @default.
• W4291020925 cites W2162499932 @default.
• W4291020925 cites W2170419728 @default.
• W4291020925 cites W2225937646 @default.
• W4291020925 cites W2236095581 @default.
• W4291020925 cites W2340745218 @default.
• W4291020925 cites W2372521228 @default.
• W4291020925 cites W2400240907 @default.
• W4291020925 cites W2486025277 @default.
• W4291020925 cites W2559913225 @default.
• W4291020925 cites W2583773865 @default.
• W4291020925 cites W2587599730 @default.
• W4291020925 cites W2620442128 @default.
• W4291020925 cites W2753603579 @default.
• W4291020925 cites W2773567595 @default.
• W4291020925 cites W2774186378 @default.
• W4291020925 cites W2793108962 @default.
• W4291020925 cites W2800452439 @default.
• W4291020925 cites W2884331333 @default.
• W4291020925 cites W2885464830 @default.
• W4291020925 cites W2887908119 @default.
• W4291020925 cites W2937988605 @default.
• W4291020925 cites W2944591790 @default.
• W4291020925 cites W2945776346 @default.
• W4291020925 cites W2955669213 @default.
• W4291020925 cites W2971121646 @default.
• W4291020925 cites W2977701891 @default.
• W4291020925 cites W2978905037 @default.
• W4291020925 cites W2979669239 @default.
• W4291020925 cites W2988825198 @default.
• W4291020925 cites W2989714602 @default.
• W4291020925 cites W2990733254 @default.
• W4291020925 cites W3004435056 @default.
• W4291020925 cites W3013476530 @default.
• W4291020925 cites W3033799992 @default.
• W4291020925 cites W3039489707 @default.
• W4291020925 cites W3047013098 @default.
• W4291020925 cites W3081143885 @default.
• W4291020925 cites W3081225312 @default.
• W4291020925 cites W3090209681 @default.
• W4291020925 cites W3121030539 @default.
• W4291020925 cites W3122226502 @default.
• W4291020925 cites W3149246930 @default.
• W4291020925 cites W3168888134 @default.
• W4291020925 cites W3174930042 @default.
• W4291020925 cites W3176419677 @default.
• W4291020925 cites W3189638887 @default.
• W4291020925 cites W3193235957 @default.
• W4291020925 cites W3196661907 @default.
• W4291020925 cites W3217757223 @default.
• W4291020925 cites W4211263994 @default.
• W4291020925 cites W4226305059 @default.
• W4291020925 cites W4236357546 @default.
• W4291020925 cites W4245132908 @default.
• W4291020925 cites W4291020925 @default.
• W4291020925 cites W4361868971 @default.
• W4291020925 doi "https://doi.org/10.1002/14651858.cd013083.pub2" @default.
• W4291020925 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/35938605" @default.
• W4291020925 hasPublicationYear "2022" @default.
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