Prognostication in Acute Pulmonary Embolism (IPEP)

Effect of a Prognostic Algorithm to Reduce Length of Stay in Acute Pulmonary Embolism: a Randomized Controlled Trial

To evaluate the effect of a prognosis-guided vs standard medical therapy in the: 1) duration of hospital stay; 2) cost-effectiveness; 3) satisfaction and quality of life; 4) in-hospital and 30-day all-cause mortality; and 5) 30-day readmissions in normotensive patients with acute symptomatic pulmonary embolism (PE). Design: Prospective, randomized, controlled, single blind trial. Normotensive patients with acute symptomatic PE will be randomly assigned to follow a prognosis-guided treatment, or to receive usual care. Setting: Respiratory, Medicine and Emergency Departments in 15 Spanish hospitals. Analyses: Data for the primary and secondary end points will be analyzed according to the intention-to -treat principle. The intention-to-treat analysis will include all randomly assigned patients. For the efficacy end points, investigators will use the Mann-Whitney U test. We will also use competing risk regression models according to Fine and Gray. For the safety end points, comparisons will be made with the use of the chi-square test. Separate analyses will be done in key prespecified subgroups of patients, according to age and hospital size.

Duration of bed rest and duration of length of stay will be guided according to a predefined prognostic algorithm.

Inclusion Criteria: Confirmed PE by objective testing Signed and dated informed consent of the subject available before the start of any specific trial procedures Exclusion Criteria: Pregnancy Haemodynamic instability Contraindication to anticoagulant therapy Life expectancy less than 3 months Participation in other clinical trials during the present clinical trial Use of a fibrinolytic agent, surgical thrombectomy, interventional (transcatheter) thrombus aspiration or lysis, or use of a cava filter to treat the index episode of PE Inability to the follow-up visits

Jimenez D, Rodriguez C, Pintado B, Perez A, Jara-Palomares L, Lopez-Reyes R, Ruiz-Artacho P, Garcia-Ortega A, Bikdeli B, Lobo JL; IPEP investigators. Effect of Prognostic Guided Management of Patients With Acute Pulmonary Embolism According to the European Society of Cardiology Risk Stratification Model. Front Cardiovasc Med. 2022 Apr 12;9:872115. doi: 10.3389/fcvm.2022.872115. eCollection 2022.

Jimenez D, Rodriguez C, Leon F, Jara-Palomares L, Lopez-Reyes R, Ruiz-Artacho P, Elias T, Otero R, Garcia-Ortega A, Rivas-Guerrero A, Abelaira J, Jimenez S, Muriel A, Morillo R, Barrios D, Le Mao R, Yusen RD, Bikdeli B, Monreal M, Lobo JL; IPEP investigators. Randomised controlled trial of a prognostic assessment and management pathway to reduce the length of hospital stay in normotensive patients with acute pulmonary embolism. Eur Respir J. 2022 Feb 10;59(2):2100412. doi: 10.1183/13993003.00412-2021. Print 2022 Feb.