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For patients with intermediate-risk pulmonary embolism (PE) — evidence of right ventricular (RV) dysfunction without overt hypotension — guidelines recommend anticoagulation alone (Circulation 2019; 140:e774). However, when such patients receive anticoagulation only, they have a small but relevant excess short-term mortality risk (≈3%; NEJM JW Gen Med Aug 15 2014 and JAMA 2014; 311:2414).
Investigators randomized 550 adults with intermediate-risk proximal acute PE to receive either large-bore mechanical thrombectomy (LBMT) or catheter-directed thrombolysis (CDT) within 72 hours of hospital arrival. Patients who were unable to receive anticoagulation or with suspected chronic PEs were excluded.
Significant results for patients who received LBM…