Assessment of lytic therapy effect in patients with intermediate-high risk pulmonary embolism for prevention of chronic thromboembolic pulmonary hypertension: A randomized, double-blind trial.

ABSTRACT

Background and Aims: This study aims to compare the effectiveness of thrombolytic therapy and anticoagulation in preventing chronic thromboembolic pulmonary hypertension (CTEPH). Method: A total of 60 patients with intermediate-high risk pulmonary embolism (PE) were randomly assigned to receive either thrombolytic therapy (n = 30) or anticoagulation (n = 30). Results: Echocardiographic assessments demonstrated no significant differences between the two treatment approaches in terms of right ventricular size (RVS) (on discharge in thrombolytic group 31.17 ± 3.43 vs. anticoagulant group 32.73 ± 5.27, p = 0.912), tricuspid annular plane systolic excursion (TAPSE) (on discharge in thrombolytic group 17.66 ± 2.39 vs. anticoagulant group 16.73 ± 2.93, p = 0.290), and systolic pulmonary artery pressure (SPAP) (on discharge in thrombolytic group 32.93 ± 9.73 vs. anticoagulant group 34.46 ± 9.30, p = 0.840). However, significant changes were observed in all assessed parameters within each treatment group (p < 0.001). The 6-month follow-up showed no significant difference between the two groups in terms of CTEPH incidence (p = 0.781) or functional class of the patients (p = 0.135). Conclusion: Based on the findings of this study, neither thrombolytic therapy nor anticoagulation demonstrated superiority over the other in reducing adverse outcomes associated with intermediate-high risk PE, including right ventricular size, SPAP, TAPSE, or CTEPH.