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What I was really looking for were a mysteriously quoted 8 RCT of thrombolytics in PE with increased ICH/bleeding outcomes.
We just did a JC and included the most recent RCT in NEJM.
(JC Menu:
1)Association Between Thrombolytic Treatment and the Prognosis of
Hemodynamically Stable Patients With Major Pulmonary Embolism :
Results of a Multicenter Registry
2)Thrombolysis or Heparin Therapy in Massive Pulmonary Embolism with
right ventricular Dilation: Results from a 128-Patient Monocenter
Registry
3)Heparin plus Alteplase Compared with Heparin alone in Patients
with Submassive Pulmonary Embolism)
This last article (from this years NEJM) seems to indicate that death and serious bleeding is less in the Alteplase + heparin. Now, this is counterintuitive but I don't think that it can be completely dismissed.
Its a blinded RCT study. It has clear outcomes (although no NNT/NNH) and used ITT analysis.
Possiblities for the difference? PE Is not the same disease as MI or Stroke. The clot load is much larger and this could *possibly* be the reason for a difference.
And attending said that there are 8 RCT showing that lytics increase mortality adn bleeding when used in PE. I can't find them. anywhere. I can find MI, stroke, but not PE. Am I brainfarting?
What do you guys think? Its very compelling. I'm not ready to start lysing stable massive (>1/3 pulm vasc) PE's, but I'm not ready to say NEVER.
We just did a JC and included the most recent RCT in NEJM.
(JC Menu:
1)Association Between Thrombolytic Treatment and the Prognosis of
Hemodynamically Stable Patients With Major Pulmonary Embolism :
Results of a Multicenter Registry
2)Thrombolysis or Heparin Therapy in Massive Pulmonary Embolism with
right ventricular Dilation: Results from a 128-Patient Monocenter
Registry
3)Heparin plus Alteplase Compared with Heparin alone in Patients
with Submassive Pulmonary Embolism)
This last article (from this years NEJM) seems to indicate that death and serious bleeding is less in the Alteplase + heparin. Now, this is counterintuitive but I don't think that it can be completely dismissed.
Its a blinded RCT study. It has clear outcomes (although no NNT/NNH) and used ITT analysis.
Possiblities for the difference? PE Is not the same disease as MI or Stroke. The clot load is much larger and this could *possibly* be the reason for a difference.
And attending said that there are 8 RCT showing that lytics increase mortality adn bleeding when used in PE. I can't find them. anywhere. I can find MI, stroke, but not PE. Am I brainfarting?
What do you guys think? Its very compelling. I'm not ready to start lysing stable massive (>1/3 pulm vasc) PE's, but I'm not ready to say NEVER.
