AVF Journal Club: PE Bleeding Data and HI-PEITHO Design

Real-World Data Challenges Assumptions on Lytic Bleeding Risk

Across roughly 4,000 patients in a 16 site electronic record database, mechanical thrombectomy was associated with more hemoglobin drop, transfusions, major bleeding, and unexpectedly more intracranial hemorrhage than ultrasound assisted thrombolysis, with no difference in length of stay or death.

HI-PEITHO Trial Design: NEWS Score-Guided Crossover

This Boston Scientific and PERT Consortium trial randomizes intermediate high risk PE patients to thrombolysis or anticoagulation, using an objective early warning score rather than clinical judgment to guide crossover, with an adaptive sample size and outcomes followed to one year.

Clinical Pearls: Blood Loss and Flow Saver Limitations

Panelists noted current blood return devices remain crude and unproven against hemolysis, that thrombectomy often aspirates more blood than thrombus, and that catheter size and physician preference, not settled evidence, still drive most choices.

Clinical Pearls: Case-Based Decisions for High-Risk PE

Presenters chose thrombectomy over lytics after recent neurosurgery given bleeding risk, favored prolonged catheter-directed lysis for more chronic-appearing clot, and cautioned against anchoring on one modality since both remain valuable.