There is limited evidence regarding durable effects on improving RV function with CDT compared with anticoagulation monotherapy in patients with acute intermediate-high-risk PE.In those who meet these criteria and have non-prohibitive bleeding risk, systemic thrombolysis or CDT may be considered to improve RV performance immediately. Among those who remain hemodynamically stable, a careful assessment for factors that elevate the risk of decompensation should be undertaken, including elevated pulmonary embolism severity index (PESI) or simplified PESI score, severe PE-related functional impairment, and objective signs of severely diminished end-organ perfusion or stroke volume.If patients deteriorate (hemodynamic, respiratory, or RV function), more intensive therapies, including thrombolysis, catheter-based or surgical embolectomy, and mechanical circulatory support, should be strongly considered.American Heart Association Scientific Statement (2019) 1.Percutaneous CDT should be considered for patients with high-risk PE, in whom thrombolysis is contraindicated or has failed (Class IIa, level C).Surgical embolectomy or CDT should be considered for patients with hemodynamic deterioration on anticoagulation treatment (Class IIa, level C).European Society of Cardiology Guidelines (2019) 6.There is uncertainty regarding the long-term improvement of RV function after treatment with CDT compared with systemic thromboloysis or anticoagulation monotherapy. Prior trials evaluating CDT in the treatment of acute PE have focused on imaging surrogates for improved short-term outcomes, such as RV:LV ratio.There are currently no data to support short-term mortality benefits with catheter-based approaches for the treatment of PE. CDT has been proven to have favorable hemodynamic outcomes and lower bleeding complications in patients with submassive/intermediate-high risk PE.The goal of CDT is to achieve reperfusion similar to systemic thrombolysis, while decreasing the rate of major and intracranial bleeding, by delivering a localized, lower thrombolytic dose.In patients with submassive or intermediate-risk PE (defined as patients without acute hypotension but with biologic and/or imaging evidence of acute right ventricular dysfunction), systemic thrombolysis has been shown to improve hemodynamic outcomes, but is associated with an elevated risk of intra- and extracranial hemorrhage.The thrombolytics currently used are alteplase, tenecteplase, reteplase, urokinase, and streptokinase. This is different from systemic thrombolysis, which involves the peripheral intravenous administration of thrombolytics, with higher doses of medication over a shorter period of time. Catheter-directed thrombolysis (CDT) refers to the administration of a thrombolytic drug directly into the pulmonary arterial circulation, generally over 24-48 hours, with a maximal dosage of thrombolytic.The role of reperfusion therapy (also known as “escalation of care”) for the treatment of intermediate-high risk pulmonary embolism (PE) is not well established.Anticoagulation in Patients With Acute Intermediate-High–risk Pulmonary Embolism: The CANARY Randomized Clinical TrialĪuthors: Parham Sadeghipour, Yaser Jenab, Jamal Moosavi, Kaveh Hosseini, Bahram Mohebbi, Ali Hosseinsabet, Saurav Chatterjee, Hamidreza Pouraliakbar, Shapour Shirani, Mehdi H Shishehbor, Azin Alizadehasl, Melody Farrashi, Mohammad Ali Rezvani, Farnaz Rafiee, Arash Jalali, Sina Rashedi, Omid Shafe, Jay Giri, Manuel Monreal, David Jimenez, Irene Lang, Majid Maleki, Samuel Z Goldhaber, Harlan M Krumholz, Gregory Piazza, Behnood Bikdeli Table of contents for the CANARY Trial summary:Ĭatheter-Directed Thrombolysis vs. This Journal Club focuses on the CANARY Trial For more information, check out the CardioNerds Journal Club Page. Narratives in Cardiology: A PA-ACC CollaborationĬardioNerds Journal Club is a monthly forum for CardioNerds to discuss and breakdown recent publications on twitter and are produced with a corresponding infographic and detailed blog post.
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