Pulmonary embolism

Question 1

Outpatient v.s Inpatient

Answer 1

• MAPPET-3 (2002): Early outpatient treatment of hemodynamically stable pulmonary embolism with low-molecular weight heparin is as safe and effective as inpatient treatment with intravenous unfractionated heparin.

Question 2

Thrombolysis for PE

Answer 2

• PEITHO Trial (2014): In patients with intermediate-risk PE, fibrinolytic therapy prevented hemodynamic decompensation but increased the risk of major hemorrhage and stroke.

Question 3

Thrombolysis in Submassive PE

Answer 3

• MOPETT Trial (2013): Thrombolytic therapy in moderate PE (submassive) may prevent the development of pulmonary hypertension, while the risk of associated intracranial hemorrhage appears to be low. However, it should be noted that this trial was relatively small and not powered to definitively prove the safety of thrombolysis in this population.

Question 4

Direct Oral Anticoagulants (DOACs) for PE

Answer 4

• AMPLIFY Trial (2013): Apixaban (a DOAC) was found to be noninferior to conventional therapy for the treatment of acute venous thromboembolism, with significantly less bleeding.
• EINSTEIN-PE Trial (2012): Oral rivaroxaban (a DOAC) is noninferior to standard therapy for the treatment of PE and has a similar risk of bleeding.

Question 5

IVC Filters

Answer 5

• PREPIC Study (1998): Showed that the use of IVC filters in addition to anticoagulation in patients with PE reduced the incidence of subsequent PE but increased the risk of DVT and did not affect overall survival.