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Pulmonary Embolism Treatments Are Evolving, Says Dr Parth Rali


There are several closely watched randomized trials examining catheter-directed therapies for acute pulmonary embolism, according to Parth Rali, MD, an associate professor of thoracic medicine and surgery at the Lewis Katz School of Medicine and director of the Temple University Health System Pulmonary Embolism Response Team.

Therapies for acute pulmonary embolism (PE)—the third most common cause of cardiovascular morbidity and mortality—are transitioning to more specific, localized treatments, said Parth Rali, MD, an associate professor of thoracic medicine and surgery at the Lewis Katz School of Medicine, director of the Temple University Health System Pulmonary Embolism Response Team (PERT), and chair of the National PERT Consortium Protocol Committee.


Can you discuss the trials mentioned in your CHEST 2022 session about the latest in acute pulmonary embolism (PE)?

I think it's an exciting world. In 2022, we have come a long way in terms of the treatment. PE treatment has evolved a lot. And at least this year, we have actually not only 1, 2, but at least 4 to 5 clinical trials. And the reason being clinical trials is that they are big, randomized, multi-center, multi-country trials, and they are looking at the various PE treatment options. Some of them are comparing different types of catheter-based therapies. Some of them are comparing standard of care anticoagulation with catheter-based therapy. It's an exciting time. I think the field of PE is at the journey where the treatments are evolving. And I think very soon, we'll have the answers to all these randomized control trials. So hopefully, when we present next year, we would have some of the trial results—we don't have to discuss just the trial designs that we did just in the session today.

What are the key takeaways that you want people to know about pulmonary embolism?

For so long, the treatment of PE consists of 2 treatments, mainly one of them is anticoagulation, which is still the standard of care that everybody with a blood clot should be on—blood thinner. And other form of treatment was a thrombolysis, which is a systemic, meaning that you give a clot buster medication through the IV. And some patients still need that. But clot buster carries the risk of bleeding.

The field has evolved into having different types of local procedures, where you place the catheters into the clot and dissolve the clot. Or sometimes you can place the catheter in the clot and suck out the clot. And those seem to be much safer, but obviously needs a lot of coordination and needs a robust clinical data.

I think some of the catheter-directed treatments needs to be related in terms of safety, in terms of efficacy, and in terms of patient-centered outcomes.

For some of the clinical trials, we’re looking at different endpoints. Some of them are looking at, “Are we preventing a patient from getting much sicker into their course?” Some of them are looking at, “What are those patients doing 6 months, 8 months, a year out after the treatment, and what are the long-term consequences of pulmonary embolism?”

We know that 15% of patients who get an acute blood clot will be short of breath or will be impaired after an acute event. And I think this is where we need to have robust clinical data. I think it's not only 1 trial, but all the trials have slightly different endpoints, which is extremely meaningful to the patient-centered outcomes.

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