MOPETT Trial (Multicenter Observational Study of Pulmonary Embolism Thrombolysis)-2013

 MOPETT trial (Multicenter Observational Study of Pulmonary Embolism Thrombolysis) was a randomized controlled trial that evaluated the efficacy and safety of low-dose thrombolysis in patients with acute intermediate-risk pulmonary embolism (PE). 

The trial included 121 patients who were randomly assigned to receive either low-dose alteplase (50 mg) or low-dose heparin plus placebo. 

The primary endpoint of the trial was the development of pulmonary hypertension at 28 months. The secondary endpoints were recurrent PE at 28 months and major bleeding events. 

The results of the trial showed that low-dose alteplase significantly reduced the risk of developing pulmonary hypertension at 28 months compared to low-dose heparin plus placebo (28% vs. 56%).

There was no significant difference between the two groups in the risk of recurrent PE or major bleeding events. 

The MOPETT trial provides evidence that low-dose thrombolysis is an effective and safe treatment option for patients with acute intermediate-risk PE.

Key findings of the MOPETT Trial included: 

1.    Reduced right ventricular strain: The trial showed that catheter-directed thrombolysis with alteplase significantly reduced right ventricular strain, which is a common complication of acute PE and can lead to poor outcomes. 

2.    Improved hemodynamics: Patients who received thrombolysis showed better improvement in their hemodynamic status compared to those treated with anticoagulation alone. 

3.    No significant difference in major bleeding events: The trial found that while thrombolysis increased the risk of minor bleeding events, there was no significant increase in major bleeding events when compared to anticoagulation therapy alone. 

4.    Suggested benefit for select patients: The results suggested that catheter-directed thrombolysis with alteplase may be particularly beneficial for a subset of patients with acute PE who have significant right ventricular strain and hemodynamic instability.

5.    The trial also suggests that low-dose thrombolysis may be particularly beneficial in preventing the development of pulmonary hypertension, a serious complication of PE. 

Here is a summary of the key findings of the MOPETT trial: Low-dose alteplase (50 mg) significantly reduced the risk of developing pulmonary hypertension at 28 months compared to low-dose heparin plus placebo (28% vs. 56%). There was no significant difference between the two groups in the risk of recurrent PE or major bleeding events. Low-dose thrombolysis is an effective and safe treatment option for patients with acute intermediate-risk PE. Low-dose thrombolysis may be particularly beneficial in preventing the development of pulmonary hypertension. 

It is important to note that the MOPETT trial was a small study, and further research is needed to confirm these findings. However, the results of the MOPETT trial provide promising evidence that low-dose thrombolysis may be a valuable treatment option for patients with acute intermediate-risk PE.