Fayad Al-Haimus։ HI-PEITHO Shows Reduced PE Complications Without Increased Bleeding
Fayad Al-Haimus, Adult Thrombosis Fellow at McMaster University, shared a post on LinkedIn about a recent article by Kenneth Rosenfield et al. published in The New England Journal of Medicine (NEJM):
”The HI-PEITHO trial landed in NEJM Group last week. Worth a read if you manage PE.
The background: intermediate-high-risk PE has always been a difficult call.
Anticoagulation alone felt insufficient for the sickest patients, but systemic thrombolysis carried some bleeding risk as well (approximately 2% intracranial hemorrhage in PEITHO-1) to use routinely.
HI-PEITHO tested low-dose alteplase delivered via catheter directly into the pulmonary artery: 544 patients, 59 sites across the US and Europe.
At 7 days, the primary composite endpoint (PE-related death, cardiopulmonary decompensation, or recurrence) occurred in 4.0% of the catheter-directed thrombolysis group versus 10.3% on anticoagulation alone, roughly a 60% relative risk reduction.
Major bleeding was similar between groups.
A few things worth keeping in mind before updating practice:
- No mortality benefit demonstrated; the signal is in short-term decompensation.
- It remains unclear whether the ultrasound component adds anything over low-dose catheter alteplase alone.
The trial gives the field something it has been lacking; a reasonably powered RCT with a clear signal in a population that has been genuinely hard to manage.”
Title: Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism
Authors: Kenneth Rosenfield, Frederikus A. Klok, Gregory Piazza, Andrew S.P. Sharp, Fionnuala Ní Áinle, Michael R. Jaff, Stefano Barco, Samuel Z. Goldhaber, Nils Kucher, Irene M. Lang, Irene Schmidtmann, Keith M. Sterling, Aleksander Araszkiewicz, Vishal Arora, Rafael Cires-Drouet, John Coghlan, Lukas Hobohm, Wulf D. Ito, Kurt Jacobson, Christoph Kaiser, Grzegorz Kopec, Kristin Marx, Samuel McElwee, Nicolas Meneveau, Peter Monteleone, Jose M. Montero-Cabezas, Christoph B. Olivier, John Park, Marek Roik, Rahul Sakhuja, Andi Tego, Markus Theurl, Gautam Visveswaran, Jan Albert Vos, Michael N. Young, Federico M. Asch, Stavros V. Konstantinides
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