Trial reportCirculation2014
Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism.
Trial report in Circulation, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 12 registered trials, which are not on this map. Cited by 432 papers, 11 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Randomized, Controlled Study Comparing EKOS EkoSonic Ultrasound Accelerated Thrombolysis to Anticoagulation in the Treatment of Sub-massive Pulmonary Embolism
XENITH: Rivaroxaban for Pulmonary Embolism Managed With Catheter Directed Thrombolysis
Comparison of Standard Catheter Directed Thrombolysis vs. Ultrasound Assisted Thrombolysis for Patients With Acute Submassive Pulmonary Embolism
Quantitative Assessment of Right Ventricular Strain Utilizing Cardiac Magnetic Resonance Imaging: Development of an Optimal Measure of Treatment Response Following Catheter-directed Interventions on Sub-massive Pulmonary Embolism.
ULTRAsound-assisted Catheter vs. STAndaRd Catheter Thrombolysis for Submassive Pulmonary Embolism
Peripheral Low Dose Systemic Thrombolysis Versus Catheter Directed Acoustic Pulse Thrombolysis for Treatment of Submassive Pulmonary Embolism
Low Dose Catheter Directed Thrombolysis for Acute Intermediary-high Risk Pulmonary Embolism
Standard-dose Apixaban AFtEr Very Low-dose ThromboLYSis for Acute Intermediate-high Risk Acute Pulmonary Embolism
Fibrinolytic Deficit in Patients With Acute Pulmonary Embolism
A Randomized Trial of Ultrasound-facilitated, Catheter-directed, Thrombolysis Versus Anticoagulation for Acute Intermediate-high Risk Pulmonary Embolism: The Higher-risk Pulmonary Embolism Thrombolysis Study
A Multicentre, Randomized Trial of Catheter-directed Thrombolysis in Intermediate-high Risk Acute Pulmonary Embolism (PRAGUE-26)
ULTRAsound-assisted Catheter-guided Thrombolysis for Intermediate-high Risk Patients With Pulmonary Embolism
Who cites it
432 citing papers in PubMed, 11 syntheses or guidelines pooled it, 1,073 citations in OpenAlex.
- Catheter-directed thrombolysis versus anticoagulation for intermediate-risk and high-risk pulmonary embolism: a systematic review and meta-analysis.Open heart · 2026Pooled it
- Catheter-Directed Mechanical Thrombectomy without Thrombolysis for Intermediate-to-High-Risk Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis.Cardiovascular and interventional radiology · 2026Pooled it
- Impact of catheter-directed thrombolysis on the socio-economic burden of pulmonary embolism in Germany: a cost-effectiveness analysis.European heart journal. Quality of care & clinical outcomes · 2026Pooled it
- Mechanical Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolism: A Systematic Review and Meta-Analysis.Cardiovascular and interventional radiology · 2026Pooled it
- Comparison of safety and efficacy of ultrasound-accelerated thrombolysis vs. standard catheter-directed thrombolysis for the management of acute pulmonary embolism - a systematic review and meta-analysis.Journal of thrombosis and thrombolysis · 2025Pooled it
- Anticoagulant Impact on Clinical Outcomes of Pulmonary Embolism Compared With Thrombolytic Therapy; Meta-Analysis.Clinical cardiology · 2024Pooled it
- Current Insights for Catheter-Directed Therapies in Acute Pulmonary Embolism: Systematic Review and Our Single-Center Experience.Anatolian journal of cardiology · 2023Pooled it
- Systemic thrombolysis with newer thrombolytics vs anticoagulation in acute intermediate risk pulmonary embolism: a systematic review and meta-analysis.BMC cardiovascular disorders · 2023Pooled it
- Role of Intravascular Ultrasound in Pulmonary Embolism Patients Undergoing Mechanical Thrombectomy: A Systematic Review.Tomography (Ann Arbor, Mich.) · 2023Pooled it
- Catheter-directed thrombolysis compared with systemic thrombolysis and anticoagulation in patients with intermediate- or high-risk pulmonary embolism: systematic review and network meta-analysis.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Pooled it
- Mortality and bleeding associated with the management of sub-massive pulmonary embolism: a systematic review and Bayesian network meta-analysis.Scientific reports · 2023Pooled it
- Treatment of acute pulmonary embolism after catheter-directed thrombolysis with dabigatran vs warfarin: Results of a multicenter randomized RE-SPIRE trial.Journal of vascular surgery. Venous and lymphatic disorders · 2024Trial
- Early Outcomes of Bolus Thrombolysis Plus Manual Aspiration Thrombectomy Using Conventional Catheters for Intermediate-High- and High-Risk Acute Pulmonary Embolism.Journal of clinical medicine · 2026Article
- Subacute Pulmonary Embolism: Insights from a National Registry of Catheter-Directed Interventions.Journal of clinical medicine · 2026Article
- Non-Ultrasound-Guided Versus Ultrasound-Guided Femoral Venous Puncture in the Interventional Pulmonary Embolism Era: Does Ultrasound Guidance Improve Safety and Feasibility?Reviews in cardiovascular medicine · 2026Article
- Optimal Duration of Ultrasound-Facilitated Catheter-Directed Thrombolysis for Acute Pulmonary Embolism: A Retrospective Cohort Study.Biomedicines · 2026Article
- Catheter-Based Therapies for Intermediate-High Risk Pulmonary Embolism: A Protocol for a Systematic Review With Bayesian Pairwise and Network Meta-Analyses.Acta anaesthesiologica Scandinavica · 2026Review
- Predictors of 90-Day Mortality and the Association of Reperfusion Therapy with 90-Day Mortality in Intermediate-High and High-Risk Pulmonary Embolism: A Real-World Multidisciplinary Cohort Study.Life (Basel, Switzerland) · 2026Article
- [Modern therapy of pulmonary embolism with PERT and EKOS: an advantage also for in-hospital time?]Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026Article
- Short-term outcomes of ultrasound-assisted catheter-directed thrombolysis and mechanical thrombectomy in management of intermediate-risk pulmonary embolism.Journal of vascular surgery. Venous and lymphatic disorders · 2026Article
372 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
19 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn patients with acute pulmonary embolism, systemic thrombolysis improves right ventricular (RV) dilatation, is associated with major bleeding, and is withheld in many patients at risk. This multicenter randomized, controlled trial investigated whether ultrasound-assisted catheter-directed thrombolysis (USAT) is superior to anticoagulation alone in the reversal of RV dilatation in intermediate-risk patients. METHODS AND
resultsFifty-nine patients (63±14 years) with acute main or lower lobe pulmonary embolism and echocardiographic RV to left ventricular dimension (RV/LV) ratio ≥1.0 were randomized to receive unfractionated heparin and an USAT regimen of 10 to 20 mg recombinant tissue plasminogen activator over 15 hours (n=30; USAT group) or unfractionated heparin alone (n=29; heparin group). Primary outcome was the difference in the RV/LV ratio from baseline to 24 hours. Safety outcomes included death, major and minor bleeding, and recurrent venous thromboembolism at 90 days. In the USAT group, the mean RV/LV ratio was reduced from 1.28±0.19 at baseline to 0.99±0.17 at 24 hours (P<0.001); in the heparin group, mean RV/LV ratios were 1.20±0.14 and 1.17±0.20, respectively (P=0.31). The mean decrease in RV/LV ratio from baseline to 24 hours was 0.30±0.20 versus 0.03±0.16 (P<0.001), respectively. At 90 days, there was 1 death (in the heparin group), no major bleeding, 4 minor bleeding episodes (3 in the USAT group and 1 in the heparin group; P=0.61), and no recurrent venous thromboembolism.
conclusionsIn patients with pulmonary embolism at intermediate risk, a standardized USAT regimen was superior to anticoagulation with heparin alone in reversing RV dilatation at 24 hours, without an increase in bleeding complications. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01166997.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.