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July 1, 2026Open HeartOpen Access

Catheter-directed thrombolysis versus anticoagulation for intermediate-risk and high-risk pulmonary embolism: a systematic review and meta-analysis

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Why the study?

Evidence comparing catheter-directed thrombolysis with anticoagulation alone in intermediate-risk and high-risk pulmonary embolism remains inconsistent.

Does catheter-directed thrombolysis reduce all-cause mortality and major bleeding compared to anticoagulation alone in patients with intermediate-risk and high-risk pulmonary embolism?

Population

16 126 patients with intermediate-risk and high-risk PE across 18 studies

Comparison

Catheter-directed thrombolysis vs anticoagulation alone

Design

Systematic review and meta-analysis of randomised and observational studies

Authors

AMArtha MaressaFWFrengki Prabowo Saputro WijayantoCTChristopher Daniel Tristan

Discussion

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Overview

CDT may lower mortality versus anticoagulation alone in intermediate/high-risk PE; leaves open need for RCTs to confirm net benefit.

Key Points

  • To evaluate the efficacy and safety of catheter-directed thrombolysis compared with anticoagulation alone in intermediate-risk and high-risk pulmonary embolism.
  • Systematic review and meta-analysis conducted under PRISMA guidelines across PubMed, Scopus, Cochrane Library, Epistemonikos, and ProQuest through May 8, 2026.
  • Included 18 randomized and observational studies comprising 16,126 patients, assessing primary outcomes using random-effects models.
  • Catheter-directed thrombolysis was associated with significantly reduced all-cause mortality compared with anticoagulation alone (RR 0.41, 95% CI 0.32 to 0.54; p<0.0001; I²=0%).
  • Major bleeding events were not statistically significantly different between arms (RR 1.78, 95% CI 0.85 to 3.71; p=0.1259; trim-and-fill adjusted RR 0.84, 95% CI 0.39 to 1.79), with comparable rates of intracranial haemorrhage and PE-related mortality.

Structured PICO

Does catheter-directed thrombolysis reduce all-cause mortality and major bleeding compared to anticoagulation alone in patients with intermediate-risk and high-risk pulmonary embolism?

P
Population
16,126 patients with intermediate-risk and high-risk pulmonary embolism (pooled from 18 randomised and observational studies)
I
Intervention
Catheter-directed thrombolysis (CDT)
C
Comparator
Anticoagulation alone
O
Outcome
All-cause mortality and major bleedinghard clinical

Catheter-directed thrombolysis is associated with significantly lower all-cause mortality compared to anticoagulation alone in intermediate- and high-risk pulmonary embolism, without a statistically significant increase in major bleeding.

Cite This Study

Maressa et al. (2026) studied this question.

synapsesocial.com/papers/6a7cedd53991d34bc40eb09fhttps://doi.org/10.1136/openhrt-2026-004250
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients2022 · 36 citations
  2. 2Comparison of short-term changes in right ventricular function after catheter-directed thrombolysis-based therapy vs. anticoagulation alone in acute intermediate-risk pulmonary embolism2026 · 1 citations
  3. 3Ultrasound assisted thrombolysis in intermediate-risk patients with pulmonary thromboembolism2019 · 16 citations
  4. 4Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism2026 · 56 citations
  5. 5An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction1993 · 4,082 citations