458. The Golden Age of Pulmonary Embolism Randomized Controlled Trials with Dr. Jay Giri

Pulmonary embolism management is undergoing a paradigm shift as the field transitions from observational data to a "golden age" of randomized controlled trials. While systemic thrombolysis effectively improves right ventricular function, its association with intracranial hemorrhage limits its routine use in intermediate-risk patients. Current clinical practice increasingly relies on advanced interventional therapies, including catheter-directed thrombolysis and mechanical thrombectomy, which are now being rigorously evaluated in large-scale trials like HI-PEITHO, PROG-26, PEERLESS-2, and PE-TRACT. These studies prioritize clinically relevant endpoints, specifically clinical deterioration and long-term functional status, rather than just hemodynamic surrogates. Although crossover designs in these trials may bias mortality outcomes toward the null, the focus on clinical deterioration provides essential evidence to guide multidisciplinary Pulmonary Embolism Response Teams in delivering more personalized, evidence-based care for patients at varying levels of risk.