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How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey

The purpose is to investigate how the outcomes of a randomized controlled trial (RCT) of catheter-directed thrombolysis (CDT) versus anticoagulation alone for acute submassive PE would affect clinical decision-making. An online survey was sent to the Pulmonary Embolism Response Team Consortium membe...

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Autores principales: Taslakian, Bedros, Li, Clayton, Goldhaber, Samuel Z., Mikkelsen, Kathryn Z., Horowitz, James M., Kabrhel, Christopher, Barnes, Geoffrey D., Sista, Akhilesh K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406864/
https://www.ncbi.nlm.nih.gov/pubmed/30736480
http://dx.doi.org/10.3390/jcm8020215
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author Taslakian, Bedros
Li, Clayton
Goldhaber, Samuel Z.
Mikkelsen, Kathryn Z.
Horowitz, James M.
Kabrhel, Christopher
Barnes, Geoffrey D.
Sista, Akhilesh K.
author_facet Taslakian, Bedros
Li, Clayton
Goldhaber, Samuel Z.
Mikkelsen, Kathryn Z.
Horowitz, James M.
Kabrhel, Christopher
Barnes, Geoffrey D.
Sista, Akhilesh K.
author_sort Taslakian, Bedros
collection PubMed
description The purpose is to investigate how the outcomes of a randomized controlled trial (RCT) of catheter-directed thrombolysis (CDT) versus anticoagulation alone for acute submassive PE would affect clinical decision-making. An online survey was sent to the Pulmonary Embolism Response Team Consortium members and the North American Thrombosis Forum members. Participants rated their preference for CDT on a 5-point scale in 5 RCT outcome scenarios. In all scenarios, subjects in the CDT group walked farther at 1-year than those in the anticoagulation group. A total of 83.3% of patients and 67.1% of physicians preferred CDT (score > 3) if it improved exercise capacity and did not increase bleeding. In every scenario, patients scored CDT higher than physicians (p < 0.05 for each). Bleeding and clinical deterioration were independently associated with the mean score. Patients’ age, gender, and history of PE did not influence CDT scores (p = 0.083, p = 0.071, p = 0.257 respectively). For patients, 60% > 60 years, 65.5% < 60 years, 57.1% of men, and 66.3% of women preferred CDT across scenarios. In conclusion, the majority of respondents would choose CDT if it improves long-term exercise capacity and does not increase bleeding. Patients appear to accept a higher bleeding risk than physicians if CDT improves long-term exercise capacity.
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spelling pubmed-64068642019-03-22 How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey Taslakian, Bedros Li, Clayton Goldhaber, Samuel Z. Mikkelsen, Kathryn Z. Horowitz, James M. Kabrhel, Christopher Barnes, Geoffrey D. Sista, Akhilesh K. J Clin Med Article The purpose is to investigate how the outcomes of a randomized controlled trial (RCT) of catheter-directed thrombolysis (CDT) versus anticoagulation alone for acute submassive PE would affect clinical decision-making. An online survey was sent to the Pulmonary Embolism Response Team Consortium members and the North American Thrombosis Forum members. Participants rated their preference for CDT on a 5-point scale in 5 RCT outcome scenarios. In all scenarios, subjects in the CDT group walked farther at 1-year than those in the anticoagulation group. A total of 83.3% of patients and 67.1% of physicians preferred CDT (score > 3) if it improved exercise capacity and did not increase bleeding. In every scenario, patients scored CDT higher than physicians (p < 0.05 for each). Bleeding and clinical deterioration were independently associated with the mean score. Patients’ age, gender, and history of PE did not influence CDT scores (p = 0.083, p = 0.071, p = 0.257 respectively). For patients, 60% > 60 years, 65.5% < 60 years, 57.1% of men, and 66.3% of women preferred CDT across scenarios. In conclusion, the majority of respondents would choose CDT if it improves long-term exercise capacity and does not increase bleeding. Patients appear to accept a higher bleeding risk than physicians if CDT improves long-term exercise capacity. MDPI 2019-02-07 /pmc/articles/PMC6406864/ /pubmed/30736480 http://dx.doi.org/10.3390/jcm8020215 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Taslakian, Bedros
Li, Clayton
Goldhaber, Samuel Z.
Mikkelsen, Kathryn Z.
Horowitz, James M.
Kabrhel, Christopher
Barnes, Geoffrey D.
Sista, Akhilesh K.
How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey
title How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey
title_full How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey
title_fullStr How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey
title_full_unstemmed How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey
title_short How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey
title_sort how the results of a randomized trial of catheter-directed thrombolysis versus anticoagulation alone for submassive pulmonary embolism would affect patient and physician decision making: report of an online survey
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406864/
https://www.ncbi.nlm.nih.gov/pubmed/30736480
http://dx.doi.org/10.3390/jcm8020215
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