What question did this study set out to answer?

To compare the clinical efficacy and safety of catheter-directed continuous urokinase infusion versus catheter-directed rapid alteplase infusion in patients with intermediate-risk acute pulmonary embolism.

January 10, 2026Frontiers in Cardiovascular MedicineOpen Access

A comparative study of anticoagulation combined with different catheter-directed thrombolysis strategies (urokinase catheter-directed vs. alteplase infusion) in the treatment of intermediate-risk pulmonary embolism

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Key result

Catheter-directed urokinase and intraprocedural alteplase show comparable efficacy and safety for intermediate-risk PE.

Why the study?

The clinical efficacy and safety of anticoagulation combined with catheter-directed urokinase thrombolysis versus catheter-directed alteplase infusion thrombolysis in intermediate-risk acute pulmonary embolism had not been compared directly.

Does intraprocedural alteplase infusion improve clinical efficacy and safety compared to continuous urokinase infusion in patients with intermediate-risk acute pulmonary embolism?

Population

Intermediate-risk acute pulmonary embolism patients (n = 56 in UK group, n = 23 in rt-PA group)

Comparison

Continuous catheter-directed urokinase infusion vs intraprocedural catheter-directed alteplase infusion

Design

Single-center retrospective analysis

Authors

JHJinqi HuangFirst Affiliated Hospital of Guangzhou Medical University QCQ ChenPutian University

Discussion

Member takes

Implication

Should not yet change practice; hypothesis-generating for randomized trials in intermediate-risk pulmonary embolism.

Key Points

To compare the clinical efficacy and safety of catheter-directed continuous urokinase infusion versus catheter-directed rapid alteplase infusion in patients with intermediate-risk acute pulmonary embolism.
Assigned patients to continuous pulmonary artery catheter infusion of urokinase (400,000–500,000 IU/day for 2–3 days; n = 56) or intraprocedural catheter-directed alteplase infusion (20 mg over 30 min; n = 23).
Assessed pre- and post-treatment cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), right-to-left ventricular diameter ratio (RVD/LVD), and pulmonary artery obstruction index (PAOI).
The urokinase group showed significant post-treatment improvements in PAOI, RVD/LVD, NT-proBNP, and cTnI (P < 0.05), while the alteplase group showed significant improvements in PAOI, RVD/LVD, and cTnI (P < 0.05) but not NT-proBNP (P = 0.088).
Direct comparisons between the two treatment groups revealed no statistically significant differences in PAOI, RVD/LVD, NT-proBNP, or cTnI at either pre-treatment or post-treatment time points (P > 0.05).
No statistically significant differences occurred between groups regarding in-hospital mortality, bleeding adverse event rates, or hospital stay duration (P > 0.05).

Structured PICO

Does intraprocedural alteplase infusion improve clinical efficacy and safety compared to continuous urokinase infusion in patients with intermediate-risk acute pulmonary embolism?

Population

79 patients with intermediate-risk acute pulmonary embolism (imaging evidence of RV dysfunction or elevated cardiac biomarkers, time from symptom onset to treatment ≤14 days).

Intervention

Anticoagulation combined with intraprocedural catheter-directed alteplase infusion (20 mg over 30 min via pulmonary artery catheter).

Comparator

Anticoagulation combined with continuous catheter-directed urokinase infusion (400,000–500,000 IU/day for 2–3 days).

Outcome

Changes in pulmonary artery obstruction index (PAOI), right ventricular diameter/left ventricular diameter (RVD/LVD), N-terminal pro-brain natriuretic peptide (NT-proBNP), and cardiac troponin I (cTnI) before and after treatment.surrogate

Limitations

Single-center, retrospective, non-randomized controlled study with a limited sample size
Lack of long-term follow-up data (e.g., RV function, chronic thromboembolic pulmonary hypertension)
Central role of standardized anticoagulation therapy may have partially obscured potential differences

Cite This Study

Huang et al. (2026) studied this question. Catheter-directed urokinase and intraprocedural alteplase showed comparable efficacy and safety in treating intermediate-risk pulmonary embolism.

synapsesocial.com/papers/696321df91e05aa366cb82ad https://doi.org/10.3389/fcvm.2025.1675768

Topics

Pulmonary embolism

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A comparative study of anticoagulation combined with different catheter-directed thrombolysis strategies (urokinase catheter-directed vs. alteplase infusion) in the treatment of intermediate-risk pulmonary embolism

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

A comparative study of anticoagulation combined with different catheter-directed thrombolysis strategies (urokinase catheter-directed vs. alteplase infusion) in the treatment of intermediate-risk pulmonary embolism

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

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Topics

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