RecentRCT

HI-PEITHO

Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism.

The New England journal of medicine, 2026 · Multicenter randomized trial

Population: 544 intermediate-risk PE patients with RV dysfunction, troponin elevation and additional distress
Intervention: Ultrasound-facilitated catheter alteplase plus anticoagulation
Comparator: Anticoagulation alone
Primary outcome: Seven-day PE death, decompensation/collapse or symptomatic recurrence
Result: 4.0% versus 10.3%; RR 0.39 (95% CI 0.20–0.77), primarily less deterioration. Seven-day major bleeding 4.1% versus 2.2%, imprecise.

What the trial found

4.0% versus 10.3%; RR 0.39 (95% CI 0.20–0.77), primarily less deterioration. Seven-day major bleeding 4.1% versus 2.2%, imprecise.

Clinical interpretation

Not a Category-E mortality trial or proof of equal bleeding risk; does not apply to every catheter device.

Moderate certainty

Clinical Context & Relevant Topics (1)

Disease Reference

Extracardiac mechanical barriers to filling or ejection: Massive PE, Cardiac Tamponade, Tension Pneumothorax, and Auto-PEEP.