Trial reportThe New England journal of medicine2014
Fibrinolysis for patients with intermediate-risk pulmonary embolism.
Trial report in The New England journal of medicine, 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 597 papers, 7 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.
Comparison Trial Evaluating Efficacy and Safety of Single i.v. Bolus Tenecteplase Plus Standard Anticoagulation as Compared With Standard Anticoagulation in Normotensive Patients
Comparison of Standard Catheter Directed Thrombolysis vs. Ultrasound Assisted Thrombolysis for Patients With Acute Submassive Pulmonary Embolism
ULTRAsound-assisted Catheter vs. STAndaRd Catheter Thrombolysis for Submassive Pulmonary Embolism
Efficacy and Safety of Vascular Boot Warming Program After Acute DVT±PE for Earlier Resolution of Venous Thromboembolism (VTE) and Prevention of Post Thrombotic Syndrome: A Pilot Study.
Standard-dose Apixaban AFtEr Very Low-dose ThromboLYSis for Acute Intermediate-high Risk Acute Pulmonary Embolism
A Reduced Dose of Thrombolytic Treatment for Patients With Intermediate High-risk Acute Pulmonary Embolism: a Randomized Controled Trial
Fibrinolytic Deficit in Patients With Acute Pulmonary Embolism
Low-Dose Tenecteplase in Covid-19 Patients With Acute Pulmonary Embolism: A Randomized, Double-Blind, Placebo-Controlled Trial
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)
Treatment Approach in Patients Diagnosed With Pulmonary Thromboembolism With Intermediate-High Risk Interms of Early Mortality After the Establisment of Ege Pulmonary Embolism Team
Safe Delivery of Thrombolytic Treatment for Pulmonary Embolism Using ClotPro® Viscoelastic Tests
Who cites it
597 citing papers in PubMed, 7 syntheses or guidelines pooled it, 1,601 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
- Efficacy and safety of low-dose thrombolysis in intermediate-risk pulmonary embolism: a meta-analysis.Frontiers in cardiovascular medicine · 2026Pooled it
- Brazilian guidelines for the pharmacological treatment of pulmonary embolism. Official document of the Brazilian Thoracic Association based on the GRADE methodology.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia · 2025Guideline
- Anticoagulant Impact on Clinical Outcomes of Pulmonary Embolism Compared With Thrombolytic Therapy; Meta-Analysis.Clinical cardiology · 2024Pooled it
- The Effect of Thrombolysis of Deep Vein Thrombosis on Late Symptoms of Post-Pulmonary Embolism Syndrome.Journal of vascular and interventional radiology : JVIR · 2025Trial
- Trial
- 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
- Prognostic impact of the e-TAPSE ratio in intermediate-high risk pulmonary embolism patients.The international journal of cardiovascular imaging · 2024Trial
- The 2026 pulmonary embolism guideline in a regional intensive care unit: Reading the recommendations without a catheter laboratory.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- 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
- Advances in Clinical Cardiology 2025: A Summary of Key Clinical Trials.Advances in therapy · 2026Review
- Safety profile and resource utilisation associated with systemic alteplase versus unfractionated heparin in intermediate-high risk pulmonary embolism: a prospective ICU cohort study.Naunyn-Schmiedeberg's archives of pharmacology · 2026Article
- Mechanical Thrombectomy Versus Systemic Thrombolysis in Hemodynamically Unstable High-Risk Pulmonary Embolism Requiring Vasopressors: A Propensity-Matched Outcomes Analysis From TriNetX Network.Journal of the Society for Cardiovascular Angiography & Interventions · 2026Article
- Ultrasound-facilitated catheter-directed thrombolysis in acute pulmonary embolism: interpreting survival benefit under low event rates and bleeding trade-offs.Journal of thoracic disease · 2026Article
- Pulmonary thromboendarterectomy for chronic thromboembolic disease-a safe but incomplete picture.Journal of thoracic disease · 2026Article
- Article
537 more citing papers are in PubMed but not listed here.
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Authors and funding
38 authors at 20 institutions in 16 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe role of fibrinolytic therapy in patients with intermediate-risk pulmonary embolism is controversial.
methodsIn a randomized, double-blind trial, we compared tenecteplase plus heparin with placebo plus heparin in normotensive patients with intermediate-risk pulmonary embolism. Eligible patients had right ventricular dysfunction on echocardiography or computed tomography, as well as myocardial injury as indicated by a positive test for cardiac troponin I or troponin T. The primary outcome was death or hemodynamic decompensation (or collapse) within 7 days after randomization. The main safety outcomes were major extracranial bleeding and ischemic or hemorrhagic stroke within 7 days after randomization.
resultsOf 1006 patients who underwent randomization, 1005 were included in the intention-to-treat analysis. Death or hemodynamic decompensation occurred in 13 of 506 patients (2.6%) in the tenecteplase group as compared with 28 of 499 (5.6%) in the placebo group (odds ratio, 0.44; 95% confidence interval, 0.23 to 0.87; P=0.02). Between randomization and day 7, a total of 6 patients (1.2%) in the tenecteplase group and 9 (1.8%) in the placebo group died (P=0.42). Extracranial bleeding occurred in 32 patients (6.3%) in the tenecteplase group and 6 patients (1.2%) in the placebo group (P<0.001). Stroke occurred in 12 patients (2.4%) in the tenecteplase group and was hemorrhagic in 10 patients; 1 patient (0.2%) in the placebo group had a stroke, which was hemorrhagic (P=0.003). By day 30, a total of 12 patients (2.4%) in the tenecteplase group and 16 patients (3.2%) in the placebo group had died (P=0.42).
conclusionsIn patients with intermediate-risk pulmonary embolism, fibrinolytic therapy prevented hemodynamic decompensation but increased the risk of major hemorrhage and stroke. (Funded by the Programme Hospitalier de Recherche Clinique in France and others; PEITHO EudraCT number, 2006-005328-18; ClinicalTrials.gov number, NCT00639743.).
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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.