Pulmonary vascular disease & thromboembolismRandomised controlled trial
Catheter-Directed Thrombolysis in Intermediate-High–Risk Pulmonary Embolism
- Randomised controlled trial
- multicentre
- open-label
Authors' conclusion
Among patients with intermediate-high-risk acute pulmonary embolism, catheter-directed thrombolysis with alteplase plus anticoagulation therapy led to a lower risk of death from any cause, recurrent pulmonary embolism, or cardiorespiratory decompensation or collapse within 7 days after randomization than anticoagulation therapy alone.
Study context
- Population
- Intermediate-high-risk acute PE (haemodynamically stable, simplified PESI ≥1, RV dysfunction plus elevated troponin or natriuretic peptide)
- Participants
- 558 participants
- Comparison
- Thrombolysis vs Standard care
- Thrombolysisn = 280
- Standard caren = 278reference
- Primary endpoint
- Death from any cause, recurrent PE, or cardiorespiratory decompensation or collapse
- Follow-up
- Within 7 days after randomization
Primary result
As reported in the abstract
Relative risk
0.10
95% CI 0.02–0.44
P < 0.001
Events by treatment group
Thrombolysis vs Standard care
RR 0.10 (95% CI 0.02–0.44); P < 0.001
Secondary outcomes
Within, days
| Outcome | Thrombolysis | Standard care |
|---|---|---|
| Deaths | ||
| time window | 30 | 7 |
Safety
Clinically relevant bleeding (BARC) · day 7
P = 0.85
Major bleeding (GUSTO) · day 7
P = 0.54
| Outcome | Thrombolysis | Standard care | P value |
|---|---|---|---|
| Intracranial haemorrhage · day 7 | 0.7% | 0 events |
Original publication
Catheter-Directed Thrombolysis in Intermediate-High–Risk Pulmonary Embolism. N Engl J Med. Published 31 August 2026. doi:10.1056/nejmoa2608012
Summarised from the published abstract; every number is checked against it