A new study in the Anatolian Journal of Cardiology provides real-world evidence that ultrasound-assisted catheter-directed thrombolysis (USAT) offers superior outcomes compared to standard anticoagulation therapy alone in patients with intermediate-high risk (IHR) pulmonary embolism (PE) but with a balance for an increased risk of bleeding.

Current treatment guidelines for IHR PE generally avoid thrombolytic therapy due to bleeding concerns and the lack of randomized trial data. To address this gap, researchers evaluated 425 patients with IHR PE, with 203 receiving USAT and 222 receiving anticoagulants alone. The goal was to assess the effectiveness of USAT in improving right ventricle (RV) function, reducing pulmonary thrombus burden, and evaluating safety outcomes, including bleeding events and in-hospital mortality.

Results showed that USAT led to better RV function and a significantly reduced thrombus burden. However, no significant difference was seen in the RV/LV ratio. Importantly, mortality rates were similar between groups, indicating no survival advantage with USAT.

However, the bleeding events were significantly more common in the USAT group (P < .001). Despite using a moderate-dose, slow-infusion thrombolytic regimen, the risk of both major and minor bleeding was elevated.

This study highlights the clinical benefits of USAT in enhancing RV recovery and thrombus resolution in IHR-PE. However, the findings also suggest careful patient selection as there is an increased risk of bleeding.