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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2019
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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. |
format | Online Article Text |
id | pubmed-6406864 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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