A small randomized CANARY trial published in JAMA Cardiology showed favorable effects of a modified reperfusion technique for intermediate-risk pulmonary embolism (PE) without causing excessive bleeding.

Only 85 of the 94 patients (29% of them were women) finished the 3-month echocardiographic follow-up. Traditional catheter-directed thrombolysis (cCDT) with heparin and alteplase (0.5 mg/catheter/h for 24 hours) was randomly allocated to patients instead of anticoagulation monotherapy.

Overall, the primary endpoint was achieved in 2 of 46 patients in the cCDT group and 5 of 39 patients in the anticoagulation monotherapy group. At 72 hours following randomization, fewer individuals receiving cCDT were found to have a right ventricular (RV) to left ventricular (LV) i.e RV/LV ratio greater than 0.9 compared to the anticoagulation group. A 3-month composite of mortality or RV/LV more than 0.9 occurred in fewer patients assigned to cCDT group. The cCDT group experienced only one instance of non-fatal significant gastrointestinal hemorrhage.

The current investigation suggests that conventional CDT has a more beneficial long-term impact than anticoagulation monotherapy on several imaging indices measured after three months.

(Source: https://www.medpagetoday.com/cardiology/venousthrombosis/101313)