THURSDAY, April 2, 2026 (HealthDay News) -- Outcomes for acute, intermediate-risk pulmonary embolism (PE) are better with ultrasound-facilitated, catheter-directed fibrinolysis plus anticoagulation versus anticoagulation alone, according to a study published March 28 in the New England Journal of Medicine to coincide with the annual meeting of the American College of Cardiology, held from March 28 to 30 in New Orleans.
Kenneth Rosenfield, M.D., from Massachusetts General Hospital in Boston, and colleagues assessed whether anticoagulation alone is an adequate treatment for acute, intermediate-risk PE. The analysis included patients with intermediate-risk PE and at least two indicators of cardiorespiratory distress who were randomly assigned to undergo ultrasound-facilitated, catheter-directed fibrinolysis with alteplase plus anticoagulation (273 patients) or anticoagulation alone (271 patients).
The researchers found that the composite of PE-related death, cardiorespiratory decompensation or collapse, or symptomatic recurrence of PE within seven days occurred in 11 patients (4.0 percent) in the intervention group and 28 patients (10.3 percent) in the control group (relative risk, 0.39). This difference was driven primarily by a lower risk for cardiorespiratory decompensation or collapse in the intervention group. The occurrence of major bleeding was similar between the groups, both within seven days (11 patients in the intervention group and six in the control group) and 30 days (11 versus eight patients). The incidence of other serious adverse events up to 30 days was also similar between the groups.
"This trial shows that a catheter intervention can indeed be effective and improve the prognosis for patients with severe PE and elevated risk of early death or life-threatening complications," lead author Stavros V. Konstantinides, M.D., Ph.D., from the University Medical Center of the Johannes Gutenberg University in Mainz, Germany, said in a statement. "If the right patients are selected for this procedure, it can prevent patients from deteriorating and it can do so at an acceptably low risk of bleeding complications."
The study was funded by Boston Scientific.