• Temple EM

Fibrinolysis for patients with intermediate-risk pulmonary embolism

The Article:

Fibrinolysis for patients with intermediate-risk pulmonary embolism. Meyer G et al. N Engl J Med. 2014 Apr 10;370(15):1402-11.

The Idea:

Do normotensive PE patients with signs of RV dysfunction and +troponins benefit from thrombolysis in addition to standard therapy? What are the benefits and consequences of adding tenecteplase to heparin therapy in these intermediate-risk PE patients?

The Study:

A multicenter, randomized, double-blind, intention-to-treat analysis of 1005 patients with intermediate-risk PE who received either heparin alone or heparin and tenecteplase. Intermediate-risk PE was defined as normotension with CT or ECHO signs of RV dysfunction AND a positive troponin leak.

The Findings:

There was a statistically significant decrease in the primary outcome (7-day mortality or hemodynamic decompensation) and a statistically significant increase in stroke and extracranial bleeding in the tenecteplase group. There was no significant difference in 30 day mortality.

The Takeaway

The improved primary outcome in the tenecteplase group was due almost entirely to a decreased incidence of hemodynamic decompensation. There was no statistically significant difference in 7-day mortality. Given the increased bleeding risk and lack of mortality benefit at both 7 and 30 days, this study does not support the addition of tenecteplase to heparin treatment in the setting of intermediate-risk PE. However, it is possible that there are other important quality of life differences. Stay tuned for more papers from this study.

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