9/19/2023 0 Comments Canary mail trial![]() ![]() The thrombolytics currently used are alteplase, tenecteplase, reteplase, urokinase, and streptokinase. This is different from systemic thrombolysis, which involves the peripheral intravenous administration of thrombolytics, with higher doses of medication over a shorter period of time. Catheter-directed thrombolysis (CDT) refers to the administration of a thrombolytic drug directly into the pulmonary arterial circulation, generally over 24-48 hours, with a maximal dosage of thrombolytic.The role of reperfusion therapy (also known as “escalation of care”) for the treatment of intermediate-high risk pulmonary embolism (PE) is not well established.Anticoagulation in Patients With Acute Intermediate-High–risk Pulmonary Embolism: The CANARY Randomized Clinical TrialĪuthors: Parham Sadeghipour, Yaser Jenab, Jamal Moosavi, Kaveh Hosseini, Bahram Mohebbi, Ali Hosseinsabet, Saurav Chatterjee, Hamidreza Pouraliakbar, Shapour Shirani, Mehdi H Shishehbor, Azin Alizadehasl, Melody Farrashi, Mohammad Ali Rezvani, Farnaz Rafiee, Arash Jalali, Sina Rashedi, Omid Shafe, Jay Giri, Manuel Monreal, David Jimenez, Irene Lang, Majid Maleki, Samuel Z Goldhaber, Harlan M Krumholz, Gregory Piazza, Behnood Bikdeli Table of contents for the CANARY Trial summary:Ĭatheter-Directed Thrombolysis vs. This Journal Club focuses on the CANARY Trial For more information, check out the CardioNerds Journal Club Page. Narratives in Cardiology: A PA-ACC CollaborationĬardioNerds Journal Club is a monthly forum for CardioNerds to discuss and breakdown recent publications on twitter and are produced with a corresponding infographic and detailed blog post.2021 ESC Guidelines on Cardiovascular Disease Prevention.Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure.Indeed, the ongoing HI-PEITHO, PEITHO-3, PE-TRACT, and mechanical thrombectomy trials are expected to provide more answers.īetter prediction models are also needed to identify PE patients at highest risk of decompensation who would benefit from an earlier aggressive approach, Hylek suggested. "Given the heightened risk of mortality among patients with submassive PE, well-designed trials are needed to guide clinical practice in patient selection, optimal dose, timing of intervention, and effective mode of delivery," Hylek urged. Of the 94 patients enrolled (29% women), only 85 completed the 3-month echocardiographic follow-up.īikdeli's group cautioned that ultrasound-assisted CDT was not used in the study. The open-label phase III CANARY trial was conducted at two centers in Tehran, Iran, and randomized PE patients to CDT (consisting of fixed-dose alteplase for 24 hours) plus heparin or anticoagulation monotherapy. The CANARY investigators reported that there had been a significant advantage for intermediate-risk CDT recipients with respect to the primary RV recovery endpoint at 72 hours (27.0% vs 52.1%, OR 0.34, 95% CI 0.14-0.80).Īs for safety, there was only one instance of nonfatal major gastrointestinal bleeding - and no deaths - in the 3 months after CDT delivering a lower-dose thrombolytic locally to the pulmonary arteries.īikdeli and colleagues acknowledged that the majority of their study patients had low baseline bleeding risk. Participants had intermediate- to-high-risk PE, a heterogeneous, difficult-to-treat population, for which reperfusion therapy is controversial because of the bleeding risk.įor high-risk patients, on the other hand, systemic thrombolysis is indicated in clinical practice unless contraindicated by high bleeding risk. Notably, the study was ultimately underpowered to assess the primary outcome, as it had been stopped prematurely due to COVID-19 when the investigators had only recruited 94 patients. "Future should determine whether such hypothesis-generating imaging changes translate to relevant improvement in clinical outcomes." "The current study suggests a more favorable durable effect for conventional CDT compared with anticoagulation monotherapy on several 3-month imaging indices," the authors wrote in JAMA Cardiology. ![]()
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