Trial of Cath-Directed PE Treatment

Intermediate-risk pulmonary embolism (PE) puts us in a difficult position: right ventricular dysfunction and hemodynamic stress are present, but the patient isn’t overtly crashing. Anticoagulation alone can feel inadequate, but the benefits of intravenous thrombolysis come at the cost of significant bleeding. Recently, a middle path has gained traction: catheter-directed thrombolysis (Figure 1).

In this multinational trial, 544 patients with acute, intermediate-high–risk PE (right ventricular dysfunction, elevated troponin levels, and at least two signs of cardiorespiratory distress) were randomized to receive anticoagulation with or without ultrasound-facilitated, catheter-directed fibrinolysis using low-dose alteplase.