For 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 and other adverse outcomes compared with anticoagulation therapy alone, an open-label randomized trial showed.
Among 558 patients, 0.7% in the thrombolysis group experienced a composite endpoint of death from any cause, recurrence of pulmonary embolism, or cardiorespiratory decompensation or collapse within 7 days compared with 6.8% of those receiving standard-care anticoagulation alone (relative risk [RR] 0.10, 95% CI 0.02-0.44, P<0.001), reported Viktor Kocka, MD, PhD, of Charles University in Prague, at the European Society of Cardiology Congress in Munich.
This difference was mainly driven by the lower incidence of cardiorespiratory decompensation or collapse in the thrombolysis group (0.7% vs 5.4%; RR 0.13, 95% CI 0.03-0.57), Kocka and co-authors noted in the New England Journal of Medicine, where the study was published.
No deaths occurred in the thrombolysis group by day 7, while four deaths occurred in the standard-care group. By day 30, there was one death in the thrombolysis group and no deaths in the standard-care group. Recurrence of pulmonary embolism occurred in one patient receiving anticoagulation therapy and in the same two patients receiving thrombolysis who experienced cardiorespiratory decompensation or collapse.
