{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Wysdom Radio™","title":"The HI-PEITHO Trial: Intermediate Risk PE Unpacked","html":"","width":"100%","height":180,"duration":1065,"description":"This episode breaks down the landmark HI-PEITHO trial (NEJM, March 2026), a multicenter randomized controlled trial of 544 patients that finally brings clarity to the category of intermediate-risk PE.\nThe Inclusion Criteria: HI-PEITHO mandated a strict \"intermediate-high\" entry bar: RV:LV ratio > 1.0 plus dual objective signs of distress (e.g., HR > 100, BP < 110). It isolates the cohort most likely to crash.\nThe 7-Hour Rapid Protocol: We discuss the operational shift away from the legacy 24-hour ICU drip. The trial utilized a concentrated, bilateral 7-hour infusion of ~17mg Alteplase via the EkoSonic system.\n61% Risk Reduction: The headline result: US-CDT achieved a massive relative risk reduction in the primary composite endpoint (cardio-respiratory collapse or decompensation), with an event rate of 4.0% vs. 10.3% in the heparin-only arm.\nThe Safety Holy Grail: In a major win for the \"local low-dose\" strategy, there were 0% intracranial hemorrhages (ICH) in both groups. Major bleeding rates were statistically insignificant (P = 0.64), validating the safety of this sub-20mg protocol.\nMechanical Thrombectomy Question: While HI-PEITHO establishes a modern benchmark for lytics, it does not address the rise of large-bore mechanical thrombectomy. It sets the safety and stabilization bar that future MT trials must now cross.\nTune in to learn about the March 2026 data!","thumbnail_url":"https://img.transistorcdn.com/MTWsVlQNVWnqK7R-Z-jI7G_aa5KttFr_japy-P3mayc/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS81ODli/OTVlYjRiZjJlZGZi/ZDQxYmE2NDU2YmUx/Y2ZhMy5qcGc.webp","thumbnail_width":300,"thumbnail_height":300}