Assessment of lytic therapy effect in patients with intermediate‐high risk pulmonary embolism for prevention of chronic thromboembolic pulmonary hypertension: A randomized, double‐blind trial

TL;DR

This study found no significant difference between thrombolytic therapy and anticoagulation in preventing chronic thromboembolic pulmonary hypertension in patients with intermediate-high risk pulmonary embolism.

Contribution

The study provides new evidence comparing two treatment approaches for preventing CTEPH in intermediate-high risk PE patients.

Findings

No significant differences were found between the two groups in right ventricular size, TAPSE, or SPAP.

Both treatment groups showed significant improvements within themselves, but not relative to each other.

CTEPH incidence and functional class were similar between the two groups at 6-month follow-up.

Abstract

This study aims to compare the effectiveness of thrombolytic therapy and anticoagulation in preventing chronic thromboembolic pulmonary hypertension (CTEPH).

A total of 60 patients with intermediate‐high risk pulmonary embolism (PE) were randomly assigned to receive either thrombolytic therapy (n = 30) or anticoagulation (n = 30).

Echocardiographic assessments demonstrated no significant differences between the two treatment approaches in terms of right ventricular size (RVS) (on discharge in thrombolytic group: 31.17 ± 3.43 vs. anticoagulant group: 32.73 ± 5.27, p = 0.912), tricuspid annular plane systolic excursion (TAPSE) (on discharge in thrombolytic group: 17.66 ± 2.39 vs. anticoagulant group: 16.73 ± 2.93, p = 0.290), and systolic pulmonary artery pressure (SPAP) (on discharge in thrombolytic group: 32.93 ± 9.73 vs. anticoagulant group: 34.46 ± 9.30, p = 0.840). However, significant changes were observed in all assessed parameters within each treatment group (p < 0.001). The 6‐month follow‐up showed no significant difference between the two groups in terms of CTEPH incidence (p = 0.781) or functional class of the patients (p = 0.135).

Based on the findings of this study, neither thrombolytic therapy nor anticoagulation demonstrated superiority over the other in reducing adverse outcomes associated with intermediate‐high risk PE, including right ventricular size, SPAP, TAPSE, or CTEPH.

Figures