EBQ:MOPETT Trial - Revision history

Dhsieh: link error

2016-09-07T05:11:48Z

link error

← Older revision		Revision as of 05:11, 7 September 2016
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	*[http://emcrit.org/wee/mopett-trial/ EMCrit - The Mopett Trial]		*[http://emcrit.org/wee/mopett-trial/ EMCrit - The Mopett Trial]
	*[http://emnerd.com/adventure-greek-interpreter-revisited/ EM Nerd - The Adventure of the Greek Interpreter Revisited]		*[http://emnerd.com/adventure-greek-interpreter-revisited/ EM Nerd - The Adventure of the Greek Interpreter Revisited]
	*[https://www.wikijournalclub.org/wiki/MOPETT/ Wiki Journal Club - MOPETT Trial]		*[https://www.wikijournalclub.org/wiki/MOPETT Wiki Journal Club - MOPETT Trial]

	==Funding==		==Funding==

Dhsieh: fixed error in syntax

2016-09-07T05:10:40Z

fixed error in syntax

← Older revision		Revision as of 05:10, 7 September 2016
Line 131:		Line 131:
	*[http://emcrit.org/wee/mopett-trial/ EMCrit - The Mopett Trial]		*[http://emcrit.org/wee/mopett-trial/ EMCrit - The Mopett Trial]
	*[http://emnerd.com/adventure-greek-interpreter-revisited/ EM Nerd - The Adventure of the Greek Interpreter Revisited]		*[http://emnerd.com/adventure-greek-interpreter-revisited/ EM Nerd - The Adventure of the Greek Interpreter Revisited]
	*[https://www.wikijournalclub.org/wiki/MOPETT / Wiki Journal Club - MOPETT Trial]		*[https://www.wikijournalclub.org/wiki/MOPETT/ Wiki Journal Club - MOPETT Trial]

	==Funding==		==Funding==

Dhsieh: additional link to mopett trial

2016-09-07T05:10:04Z

additional link to mopett trial

← Older revision		Revision as of 05:10, 7 September 2016
Line 131:		Line 131:
	*[http://emcrit.org/wee/mopett-trial/ EMCrit - The Mopett Trial]		*[http://emcrit.org/wee/mopett-trial/ EMCrit - The Mopett Trial]
	*[http://emnerd.com/adventure-greek-interpreter-revisited/ EM Nerd - The Adventure of the Greek Interpreter Revisited]		*[http://emnerd.com/adventure-greek-interpreter-revisited/ EM Nerd - The Adventure of the Greek Interpreter Revisited]
			*[https://www.wikijournalclub.org/wiki/MOPETT / Wiki Journal Club - MOPETT Trial]

	==Funding==		==Funding==
	*Not reported		*Not reported

Neil.m.young at 11:26, 4 May 2016

2016-05-04T11:26:07Z

← Older revision		Revision as of 11:26, 4 May 2016
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	*Not reported		*Not reported

	==~~Sources~~==		==References==
	<references/>		<references/>

	[[Category:EBQ]][[Category:Pulmonary]]		[[Category:EBQ]][[Category:Pulmonary]]

Neil.m.young at 11:25, 4 May 2016

2016-05-04T11:25:52Z

← Older revision		Revision as of 11:25, 4 May 2016
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	==Funding==		==Funding==
	*Not reported		*Not reported


	==Sources==		==Sources==

Ostermayer: Text replacement - "Category:Pulm" to "Category:Pulmonary"

2016-03-22T16:11:40Z

Text replacement - "Category:Pulm" to "Category:Pulmonary"

← Older revision		Revision as of 16:11, 22 March 2016
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	<references/>		<references/>

	[[Category:EBQ]][[Category:~~Pulm~~]]		[[Category:EBQ]][[Category:Pulmonary]]

Ostermayer: /* Criticisms & Further Discussion */

2014-07-28T11:52:40Z

Criticisms & Further Discussion

← Older revision		Revision as of 11:52, 28 July 2014
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	*Even patients with unfractionated heparin and LMWH experience bleeding at a rate ranging between 1-2%. Since patients received both in this trial in addition to a tPA treatment arm, it is suspicious that no bleeding events were reported. <ref>van Dongen C. et al. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev. 2004 Oct 18;(4) PMID: 15495007</ref>		*Even patients with unfractionated heparin and LMWH experience bleeding at a rate ranging between 1-2%. Since patients received both in this trial in addition to a tPA treatment arm, it is suspicious that no bleeding events were reported. <ref>van Dongen C. et al. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev. 2004 Oct 18;(4) PMID: 15495007</ref>
	*No reports of troponin or right ventricular dysfunction rates so direct comparison to the [[EBQ:PEITHO Trial]] is not possible.		*No reports of troponin or right ventricular dysfunction rates so direct comparison to the [[EBQ:PEITHO Trial]] is not possible.
	*Meta-analysis shows that patients with pulmonary embolism, including those who were hemodynamically stable with right ventricular dysfunction, thrombolytic therapy was associated with lower rates of all-cause mortality and increased risks of major bleeding and ICH<ref>Chatterjee S. et al. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA. 2014 Jun 18;311(23):2414-21. PMID 24938564</ref>		*Meta-analysis shows that patients with pulmonary embolism, including those who were hemodynamically stable with right ventricular dysfunction, thrombolytic therapy was associated with lower rates of all-cause mortality and increased risks of major bleeding and ICH.<ref>Chatterjee S. et al. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA. 2014 Jun 18;311(23):2414-21. PMID 24938564</ref> Second, in a subset of 1331 pa tients older than 65 years, thrombolysis was associated with a higher rate of major bleeding (12.93% vs 4.10%)<ref>Beckman JA. Thrombolytic therapy for pulmonary embolism. JAMA. 2014;311(23):2385–2386. doi:10.1001/jama.2014.5993.</ref>

	==See Also==		==See Also==

Ostermayer: /* See Also */

2014-07-23T13:27:50Z

Ostermayer: /* Major Points */

2014-07-23T13:26:09Z

Major Points

← Older revision		Revision as of 13:26, 23 July 2014
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	==Major Points==		==Major Points==
	The American Heart Association has maintained that for massive pulmonary embolism, thrombolysis with tPA is an effective treatment strategy.<ref>Jaff M. et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011 Apr 26;123(16):1788-830</ref>. This trial addressed thrombolysis in patients who are hemodynamically stable but had ~~right ventricular enlargement, hypokinesis, or an elevation of cardinal biomarkers~~. ~~This~~ group ~~is commonly~~ termed, sub-massive PE. The standard of treatment for the sub-massive PE group has been unclear and thrombolysis has not been standard care for treatment, with most of these patients receiving heparin to decrease clot propagation while clot is slowly broken down<ref>Konstantinides S. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation 1997;96: 882e888</ref> Half does tPA was chosen to reduce the bleeding complication which has occurred in thrombolysis.		The American Heart Association has maintained that for massive pulmonary embolism, thrombolysis with tPA is an effective treatment strategy.<ref>Jaff M. et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011 Apr 26;123(16):1788-830</ref>. This trial addressed thrombolysis in patients who are hemodynamically stable but had moderate PE evidenced on CTA. Commonly, the group termed, sub-massive PE includes patients with elevated troponin, BNP, or RV dysfunction on echocardiogram.. The standard of treatment for the [[Pulmonary_Embolism_(PE)#Submassive\|sub-massive PE]] group has been unclear and thrombolysis has not been standard care for treatment, with most of these patients receiving heparin to decrease clot propagation while clot is slowly broken down<ref>Konstantinides S. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation 1997;96: 882e888</ref> Half does tPA was chosen to reduce the bleeding complication which has occurred in thrombolysis.

	In this single study, unblinded study with an physiologic endpoint, there was a large reduction in pulmonary hypertension (16% vs. 57%) as well as in the composite endpoint of recurrent pulmonary embolism. There was no significant mortality benefit. There was no morbidity related to bleeding, causing the authors to coin the term "Safe Dose tPA" for the 0.5mg/kg dosing.		In this single study, unblinded study with an physiologic endpoint, there was a large reduction in pulmonary hypertension (16% vs. 57%) as well as in the composite endpoint of recurrent pulmonary embolism. There was no significant mortality benefit. There was no morbidity related to bleeding, causing the authors to coin the term "Safe Dose tPA" for the 0.5mg/kg dosing.

Ostermayer: /* Outcomes */

2014-07-23T13:09:46Z

Outcomes

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 ==Outcomes==
 ===Primary Outcome===
 '''Pulmonary Hypertension:'''
 *Treatment Group: 16%

← Older revision		Revision as of 13:27, 23 July 2014
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	==See Also==		==See Also==
	*[[Pulmonary Embolism (PE)]]		*[[Pulmonary Embolism (PE)]]
	*[[EBQ: PEITHO Trial]]		{{Thrombolysis Submassive PE Trials}}
	*[[EBQ: TOPCOAT Trial]]

	==External Links==		==External Links==