Assessment of lytic therapy effect in patients with intermediate‐high risk pulmonary embolism for prevention of chronic thromboembolic pulmonary hypertension: A randomized, double‐blind trial

Background and Aims This study aims to compare the effectiveness of thrombolytic therapy and anticoagulation in preventing chronic thromboembolic pulmonary hypertension (CTEPH). Method A total of 60 patients with intermediate‐high risk pulmonary embolism (PE) were randomly assigned to receive either thrombolytic therapy ( n = 30) or anticoagulation ( n = 30). Results Echocardiographic assessments demonstrated no significant differences between the two treatment approaches in terms of right ventricular size (RVS) (on discharge in thrombolytic group: 31.17 ± 3.43 vs. anticoagulant group: 32.73 ± 5.27, p = 0.912), tricuspid annular plane systolic excursion (TAPSE) (on discharge in thrombolytic group: 17.66 ± 2.39 vs. anticoagulant group: 16.73 ± 2.93, p = 0.290), and systolic pulmonary artery pressure (SPAP) (on discharge in thrombolytic group: 32.93 ± 9.73 vs. anticoagulant group: 34.46 ± 9.30, p = 0.840). However, significant changes were observed in all assessed parameters within each treatment group ( p < 0.001). The 6‐month follow‐up showed no significant difference between the two groups in terms of CTEPH incidence ( p = 0.781) or functional class of the patients ( p = 0.135). Conclusion Based on the findings of this study, neither thrombolytic therapy nor anticoagulation demonstrated superiority over the other in reducing adverse outcomes associated with intermediate‐high risk PE, including right ventricular size, SPAP, TAPSE, or CTEPH.