Catheter Fibrinolysis Cuts Decompensation in Intermediate-Risk PE

HI-PEITHO is the first randomized controlled trial to show that ultrasound-facilitated, catheter-directed fibrinolysis reduces early clinical deterioration versus anticoagulation alone in higher-risk intermediate PE without a measurable early bleeding penalty.

alteplasetissue plasminogen activatorcatheter-directed fibrinolysisEkoSonicultrasound-facilitated thrombolysispulmonary embolismintermediate-risk PEanticoagulationunfractionated heparinHI-PEITHOrandomized controlled trialright ventricular dysfunction Cardiology / Anticoagulation

Background Information

Combined therapy cuts major events in pulmonary embolism by over half.

Acute pulmonary embolism (PE) is a life-threatening condition, and optimal treatment strategies can improve patient outcomes. Ultrasound-facilitated, catheter-directed fibrinolysis improved outcomes over anticoagulation alone: primary events were 4.0% vs. 10.3% (P=0.005). The study supports combined therapy for intermediate-risk PE but highlights bleeding risks, necessitating clinician judgment in therapeutic selection. Combining ultrasound-facilitated fibrinolysis with anticoagulation reduces major events in intermediate-risk PE.

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Authors: Rosenfield K, Klok FA, Piazza G, Sharp ASP, Ní Áinle F, Jaff MR, Barco S, Goldhaber SZ, Kucher N, Lang IM, Schmidtmann I, Sterling KM, Araszkiewicz A, Arora V, Cires-Drouet R, Coghlan J, Hobohm L, Ito WD, Jacobson K, Kaiser C, Kopec G, Marx K, McElwee S, Meneveau N, Monteleone P, Montero-Cabezas JM, Olivier CB, Park J, Roik M, Sakhuja R, Tego A, Theurl M, Visveswaran G, Vos JA, Young MN, Asch FM, Konstantinides SV, HI-PEITHO Investigators

Citation: Rosenfield K, Klok FA, Piazza G, et al. Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism. The New England journal of medicine. 2026;394(20):1979-1990. doi:10.1056/NEJMoa2516567

Article Links: PubMed · Journal / DOI

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

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