Diuretic vs. placebo in intermediate-risk acute pulmonary embolism: a randomized clinical trial

The role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial. In this multicentre, double-blind trial, normotensive patients with intermediate-risk Pulmonary Embolism were randomized to receive either a single 80 mg bolus of furosemide or a placebo. Eligible patients had at least a simplified PE Severity Index (sPESI) ≥1 with right ventricular dysfunction. The primary efficacy endpoint assessed 24 h after randomization included (i) absence of oligo-anuria and (ii) normalization of all simplified PE Severity Index. Safety outcomes were worsening renal function and major adverse outcomes at 48 hours defined by death, cardiac arrest, mechanical ventilation, or need of catecholamine It was observed that the primary outcome occurred in 68/132 patients (51.5%) in the diuretic and in 49/132 (37.1%) in the placebo group with relative risk = 1.30, and significance of 0.021. Major adverse outcome at 48 h occurred in 1 patient in the diuretic group and 4 patients in the placebo group which was non-significant. Significant Increase in serum creatinine level was seen in diuretic than placebo group Thus, the study concluded that in normotensive patients with intermediate-risk PE, a single bolus of furosemide improved the primary efficacy outcome at 24 h and maintained stable renal function. In the furosemide group, urine output increased, without a demonstrable improvement in heart rate, systolic blood pressure, or arterial oxygenation. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.