New Studies Support PE Intervention in Higher-Risk Patients with Більше Severe Clinical Condition

Recent randomized studies support catheter-directed intervention over anticoagulation alone in the treatment of intermediate-to-high-risk pulmonary embolism (PE), particularly in patients with additional clinical signs of severity. Dr. Samantha Pettigrew, Assistant Professor of Clinical Thoracic Medicine at the University of Temple Lewis Katz School of Medicine, made this observation.

Pettigrew met with HCPLive following his presentation, “Pulmonary Embolism Care in 2026: New Randomized Clinical Trials and What’s Coming Next,” held during the Pulmonary Vascular Disease session on October 18-21. During the session, recent studies including HI-PEITHO, PEERLESS, and others reported over the past year were reviewed.

“When selecting your patients, if there’s someone who worries you a bit more than usual, if the situation doesn’t sit right with you, or if the patient doesn’t clearly adhere to current guidelines, it’s really important to consider escalating the level of care, discuss procedural options with the patient, and consult interventional specialists,” said Pettigrew.

In the HI-PEITHO study, in addition to intermediate-high-risk PE, 544 patients with tachycardia, hypotension without shock, or hypoxemia were randomly assigned to ultrasound-guided catheter-directed thrombolysis or anticoagulation alone. The composite endpoint of PE-related death, cardiorespiratory decompensation or collapse, or symptomatic recurrent PE occurred in 4.0% and 10.3% of patients, respectively. The difference was attributable to fewer decompensation events; no significant difference was seen in major bleeding or all-cause mortality.

PRAGUE-26 trial: Among 558 patients meeting the standard intermediate-high-risk definition, the composite endpoint of 7-day mortality, recurrent PE, or cardiac respiratory decompensation or collapse occurred in 0.7% of the catheter-guided thrombolysis group versus 6.8% in the anticoagulation-alone group (relative risk, 0.10; 95% CI, 0.02–0.44). In patients without additional severity markers, Pettigrew stated that bleeding risk assessment carried greater weight in the decision-making process.

At PEERLESS, in the first direct randomized comparison of catheter-based therapies, large-volume mechanical thrombectomy outperformed catheter-directed thrombolysis in the hierarchical win rate (5.01; 95% CI, 3.68–6.97; P < .001). This result was driven by the reduction in the lowest-ranked component, ICU utilization. When ICU outcomes were excluded, the win rate was 1.34 (95% CI, 0.78–2.35; P = .30). Pettigrew noted that no study has yet demonstrated a mortality benefit; however, he added that the reduction in ICU utilization is significant for hospital operations and for limiting the risk of delirium and infection.

1. Pulmonary embolism care in 2026: new randomized clinical trials and what’s coming next. Session: CHEST 2026 Meeting; October 18-21, 2026; Phoenix, AZ.
2. Konstantinides SV, et al. Ultrasound-facilitated catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: primary results of the HI-PEITHO randomized clinical trial. . Çevrimiçi yayın 28 Mart 2026.
3. Kroupa J, Radvan M, Mrozek J, et al. Kateter yoluyla trombolitik tedavi orta-yüksek riskli pulmoner embolizmde. . Çevrimiçi yayın 2026.
4. Jaber WA, Gonsalves CF, Stortecky S, ve ark. Orta riskli pulmoner embolide büyük çaplı mekanik trombebekçi (trombektomi) kateter yoluyla trombolizeye karşı: PEERLESS rastlantısal kontrollü çalışmanın ilk sonuçları. . 2025;151(5):260-273.