Modified pulmonary artery obstruction index for thrombolysis assessment in intermediate-risk pulmonary thromboembolism

Q: What are the key findings of this study?

Urokinase thrombolysis achieved complete pulmonary artery thrombus dissolution in 67.1% of patients with intermediate-risk acute pulmonary thromboembolism, yielding an overall efficacy rate of 100%.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Intermediate-risk acute pulmonary thromboembolism (n=85). Intervention: Urokinase thrombolysis. Primary outcome: Complete thrombus dissolution.

Q: What does this research mean for the field?

Urokinase thrombolysis administered via the dorsal foot vein achieves complete pulmonary artery thrombus dissolution in 67.1% of patients with intermediate-risk acute pulmonary thromboembolism. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Weida Wu; Jianyang Peng; Guohui Zhou; Yuanzhen Lin; Jinjia Lin; Zhicheng Weng; Qunying Lin

doi:10.1097/md.0000000000050141

August 14, 2026MedicineOpen Access

Modified pulmonary artery obstruction index for thrombolysis assessment in intermediate-risk pulmonary thromboembolism

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Key result

Urokinase thrombolysis yields complete clot dissolution in ~67% of intermediate-risk PE patients.

n=85

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Why the study?

Although acute non-high-risk PTE is generally relieved with anticoagulation, some patients experience complications, prompting this assessment of urokinase thrombolysis efficacy in intermediate-risk PTE using a modified PAOI.

Does urokinase thrombolysis improve pulmonary artery obstruction in patients with intermediate-risk acute pulmonary thromboembolism?

Key Points

To assess the efficacy and safety of urokinase thrombolytic therapy in patients with intermediate-risk acute pulmonary thromboembolism using a modified pulmonary artery obstruction index.
Retrospectively analyzed 85 patients with acute pulmonary thromboembolism and lower extremity venous thromboembolism treated between January 2018 and January 2023.
All patients underwent inferior vena cava filter placement followed by urokinase thrombolysis administered through the dorsal foot vein at average daily doses of 36.36 × 104 to 100 × 104 units.
Assessed vascular obstruction and cardiac metrics pre- and post-treatment using computed tomography pulmonary angiography, Doppler echocardiography, D-dimer levels, and the modified pulmonary artery obstruction index.
Complete pulmonary artery thrombus dissolution occurred in 67.1% (57/85) of patients, achieving an overall thrombolysis efficacy rate of 100%.
Modified PAOI index/40 decreased from 0.616 ± 0.217 to 0 (0–0.030) (P < .001), pulmonary artery diameter decreased from 31.7 ± 4.4 mm to 29.2 ± 4.3 mm (P < .001), and the artery-to-aorta diameter ratio decreased from 0.895 ± 0.154 to 0.819 ± 0.139 (P < .001).
Severe bleeding occurred in 14.1% (12/85) of patients, with total urokinase dosage (odds ratio = 1.052, P = .032) and thrombolysis duration (odds ratio = 0.012, P = .032) identified as significant independent risk factors.

Study Design

Type

Observational (n=85)

Multicenter

No

Structured PICO

Does urokinase thrombolysis improve pulmonary artery obstruction in patients with intermediate-risk acute pulmonary thromboembolism?

P

Population

85 patients (mean age 66.9 years, 63.5% female) with intermediate-risk acute pulmonary thromboembolism and lower extremity venous thromboembolism treated with urokinase thrombolysis and followed for 6 to 16 months.

I

Intervention

Inferior vena cava filter (IVCF) implantation followed by urokinase thrombolytic therapy administered through the dorsal vein of the foot on the affected side (dosage 250,000 to 1 million units/day) for a median of 6 days.

O

Outcome

Thrombolysis efficacy (complete or partial dissolution) evaluated using computed tomography pulmonary angiography (CTPA), Doppler echocardiography, D-dimer levels, and modified pulmonary artery obstruction index (PAOI).surrogate

Urokinase thrombolysis via the dorsal foot vein, combined with IVC filter placement, effectively reduces pulmonary artery obstruction in intermediate-risk acute PTE, though it carries a notable risk of severe bleeding.

Limitations

Single-center retrospective study with a relatively small cohort size.
Lack of a control group (no case-control study conducted).
Empirical choice of average daily dose of urokinase without a precise reference standard.
Limited follow-up period which may not have been long enough to confirm chronic thromboembolic pulmonary hypertension (CTEPH).
D-dimer levels can be affected by various confounding factors.

Implication

May support urokinase thrombolysis for obstruction reduction in intermediate-risk PTE; leaves open need for RCTs on safety and optimal use.

Abstract

Acute non-high-risk pulmonary thromboembolism (PTE) is generally relieved within months of anticoagulation treatment initiation. However, some patients experience complications. This study aimed to assess the efficacy of urokinase thrombolysis in intermediate-risk PTE using a modified pulmonary artery obstruction index (PAOI). We retrospectively assessed the data of 85 patients with acute PTE and venous thromboembolism of the lower extremities treated between January 2018 and January 2023. All patients underwent inferior vena cava filter implantation and thrombolysis via the dorsal foot vein. We evaluated thrombolysis efficacy using computed tomography pulmonary angiography, Doppler echocardiography, D-dimer (D-D) levels, and PAOI. The effects of age, preoperative D-D level, urokinase dosage, and thrombolysis time on efficacy and safety were analyzed. Complete thrombus dissolution in pulmonary arteries occurred in 67.1% of patients (thrombolysis efficacy, 100%). The modified PAOI/40, artery diameter, and artery-to-aorta diameter ratio showed significant improvements post-thrombolysis. The average daily usage of urokinase ranged from 36.36 × 104 to 100 × 104 units. Spearman rank correlation test revealed a relationship between PAOI change rate and pre-intervention D-D level (r = 0.291; P = .007) and average daily urokinase dosage (r = -0.341; P = .001). In multinomial logistic regression, total urokinase dosage (odds ratio = 1.052, P = .032) and thrombolysis time (odds ratio = 0.012, P = .032) were identified as significant factors. During follow-up, thromboembolism recurred in 2 cases; clinical manifestations of right heart insufficiency were not observed in other patients. Higher preoperative D-D levels may suggest a better thrombolytic effect in intermediate-risk acute PTE. An appropriate daily dosage of urokinase may yield good therapeutic effects. Managing urokinase dosage and duration helps prevent serious bleeding complications.

Discussion

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Cite This Study

Wu et al. (2026) conducted an observational in Intermediate-risk acute pulmonary thromboembolism (n=85). Urokinase thrombolysis was evaluated on Complete thrombus dissolution. Urokinase thrombolysis achieved complete pulmonary artery thrombus dissolution in 67.1% of patients with intermediate-risk acute pulmonary thromboembolism, yielding an overall efficacy rate of 100%.

synapsesocial.com/papers/6a817a11f2fb91fc834adb3a https://doi.org/10.1097/md.0000000000050141

Topics

Pulmonary embolism

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Modified pulmonary artery obstruction index for thrombolysis assessment in intermediate-risk pulmonary thromboembolism

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Modified pulmonary artery obstruction index for thrombolysis assessment in intermediate-risk pulmonary thromboembolism

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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