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

Methodology: 2/5
Usefulness: 1/5

Lim P, et al. Eur Heart J Acute Cardiovasc Care. 2022 Jan 12;11(1):2-9.

Question and Methods: Does diuresis with single-dose IV furosemide improve hemodynamic parameters and prevent oligo-anuria in normotensive patients with intermediate-risk PE? Multi-centre, placebo-controlled, double-blind trial of furosemide 80mg IV vs. placebo.
Findings: 135 of the 276 randomized patients received furosemide. 51.5% of the furosemide group achieve the composite primary outcome, compared to 37.1% in the placebo group (RR = 1.30, 95% CI 1.04-1.61; p = 0.021). No differences in major adverse outcomes were observed.
Limitations: The composite primary outcome is not patient-centered and included urine output, which is directly induced by the intervention. No explanation of how blinding was maintained. A single dose of furosemide has limited length of effect.

Interpretation: In normotensive patients with intermediate-risk PE, furosemide is unlikely to improve sPESI hemodynamic parameters, but may be beneficial in maintaining urine output.

Dr. Alexandre Coutin

JC Supervisor: Dr. Venkatesh Thiruganasambandamoorthy