Catheter-Directed Fibrinolysis With AC vs AC Alone — Managing Intermediate-Risk PE

Background: Acute pulmonary embolism (PE) presents with a wide spectrum of severity, requiring tailored therapeutic strategies based on risk. Although high-risk PE with hemodynamic instability warrants aggressive reperfusion therapies, the optimal management of intermediate-risk PE remains uncertain. These patients exhibit right ventricular (RV) dysfunction and biomarker elevation but are hemodynamically stable. Although systemic fibrinolysis reduces clinical deterioration, it increases bleeding risk, limiting its routine use. Ultrasound (US)-facilitated, catheter-directed fibrinolysis has emerged as a potential alternative, delivering lower-dose thrombolytics locally to enhance efficacy while minimizing complications. The HI-PEITHO (Higher-Risk Pulmonary Embolism Thrombolysis) trial evaluated whether this approach, combined with anticoagulation (AC), improves outcomes compared with AC alone. Objective: To determine whether US-facilitated, catheter-directed fibrinolysis plus AC reduc more...