Evidence map›Paper›PMID 41612339›Full record

ArticleThrombosis journal2026

The interaction of fibrinolysis and the complement system in patients with acute pulmonary embolism, treated with ultrasound-assisted catheter-directed thrombolysis.

Dominik F Draxler, Christopher D Barrett, Justine Brodard, Elizabeth R Maginot, Konstantina Chalkou, Heidi Ho, Charithani B Keragala, Dik Heg, Johanna A Kremer Hovinga, Ernest E Moore and 3 more

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Article in Thrombosis journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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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.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Dominik F Draxler *Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. dominik.draxler@extern.insel.ch.
Christopher D Barrett *Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Justine BrodardDepartment of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Elizabeth R MaginotDivision of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Konstantina ChalkouDepartment of Clinical Research, University of Bern, Bern, Switzerland.
Heidi HoMolecular Neurotrauma and Haemostasis, Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.
Charithani B KeragalaMolecular Neurotrauma and Haemostasis, Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.
Dik HegDepartment of Clinical Research, University of Bern, Bern, Switzerland.
Johanna A Kremer HovingaDepartment of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Ernest E MooreErnest E Moore Shock Trauma Center at Denver Health, Department of Surgery, Denver, CO, USA.
Robert L MedcalfMolecular Neurotrauma and Haemostasis, Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.
Anne Angelillo-ScherrerDepartment of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Stefan StorteckyDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Ultrasound-assisted catheter-directed thrombolysis (USAT) with recombinant tissue-type plasminogen activator (rt-PA) is widely used as a reperfusion approach for acute pulmonary embolism (PE). The fibrinolytic effector protease plasmin is known to be a potent activator of the complement system. The aim of this study was to better characterize the extent of complement activation during USAT, and its relationship with the fibrinolytic system. In this single-center cohort study of USAT for PE, pulmonary-arterial hemodynamic measurements were performed, and plasma samples obtained from 35 patients before treatment start and at 6 h (during infusion of rt-PA). Hemostatic properties were evaluated with thromboelastometry and assessment of fibrinolytic markers. In addition, levels of the complement components C3a, C4a, C5a, soluble C5b-9 (sC5b-9), Ba, Bb, factor H and factor I at these time points were determined. Several complement components, including the anaphylatoxin C3a, showed a reduction during USAT. We found a positive correlation of the plasmin-antiplasmin complex (plap complex) with factor H, yet a negative correlation with both Ba and Bb, C5a and sC5b-9. The potent plasmin-inhibitor, α2-antiplasmin, displayed a positive correlation with Ba and Bb, factor I and factor H. In addition, the anaphylatoxin C5a negatively, and Ba positively predicted treatment responsiveness to USAT. In conclusion, in the setting of acute PE and reperfusion therapy with USAT, there appears to be a competing effect between plasmin-mediated complement activation and a reduction of the inflammatory trigger by resolution of obstruction and ischemia. Complement activation in PE is downregulated during USAT, an effect exceeding the complement-activating properties of plasmin.

Indexed as

Catheter-directed thrombolysisComplementFibrinolysisFibrinolytic capacityFibrinolytic potentialInflammationPulmonary embolism

Identifiers

PMID41612339
PMCPMC12853686

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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.