Shailesh Shah

Ongoing discussion re best approach to intermediate-high/high risk PE.

What options do we have?
Anti-coag
Systemic Thrombolysis 100%, 50%, 25%
IR guided (embolectomy/CDT)
Fluid
Furosemide

The evidence is certainly in favour of IR guided therapies

However, in the spiralling obstructive shock patient, would you reach for the diuretic??

https://academic.oup.com/ehjacc/article/11/1/2/6386419

https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-13-0404/_pdf/-char/ja

https://www.jacc.org/doi/10.1016/S0735-1097%2817%2935282-8

Diuretic vs. placebo in intermediate-risk acute pulmonary embolism: a randomized clinical trial

AbstractAims. The role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial. In this multicentre, double-blind trial, we ran

OUP Academic
Oct 18, 2023 at 10:09pmWeb
Show threadLars Mølgaard SaxhaugOct 21, 2023
@ShaileshShah I think the evidence is still out on diuretics, and I think there is absolute potential for heteroegeneity of treatment effect here.
Show threadMathieu DesgroseilliersOct 23, 2023

@load_dependent @ShaileshShah very interesting topics indeed!
Agree with Lars. I prefer to reduce the afterload of the RV with pulmonary vasodilators (iMilrinone, iNO, iEpoprostenol) rather than trying to potentially reducing RV stretching with diuretics. I think it’s more effective (& quicker)

Interesting reads on this👇
https://pubmed.ncbi.nlm.nih.gov/30633959/
https://pubmed.ncbi.nlm.nih.gov/32046152/
https://pubmed.ncbi.nlm.nih.gov/35915994/
https://pubmed.ncbi.nlm.nih.gov/30633959/
https://pubmed.ncbi.nlm.nih.gov/22005573/
https://pubmed.ncbi.nlm.nih.gov/36004010
https://pubmed.ncbi.nlm.nih.gov/28298620/

Inhaled nitric oxide to treat intermediate risk pulmonary embolism: A multicenter randomized controlled trial - PubMed

NCT01939301.

PubMed