{"id":30608,"date":"2026-06-23T04:21:00","date_gmt":"2026-06-22T20:21:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=30608"},"modified":"2026-06-23T06:46:53","modified_gmt":"2026-06-22T22:46:53","slug":"30608","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=30608","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u6025\u6027\u80ba\u6813\u585e\u7684\u8d85\u58f0\u8f85\u52a9\u5bfc\u7ba1\u5f15\u5bfc\u7ea4\u6eb6\u6cbb\u7597"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism<\/h1>\n\n\n\n

Kenneth\u00a0Rosenfield,\u00a0Frederikus A.\u00a0Klok,\u00a0Gregory\u00a0Piazza,\u00a0et al<\/h3>\n\n\n\n

N Engl J Med Published\u00a0March 28, 2026<\/strong><\/h3>\n\n\n\n

DOI: 10.1056\/NEJMoa2516567<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND<\/h3>\n\n\n\n

Whether anticoagulation alone is an adequate treatment for acute, intermediate-risk pulmonary embolism is uncertain.<\/p>\n\n\n\n

METHODS<\/h3>\n\n\n\n

We conducted a multinational, adaptive-design trial with blinded outcome adjudication. Patients with intermediate-risk pulmonary embolism (with a ratio of right ventricular end-diastolic diameter to left ventricular end-diastolic diameter of \u22651.0 and an elevated troponin level) were eligible if they had at least two indicators of cardiorespiratory distress (systolic blood pressure of \u2264110 mm Hg, a heart rate of \u2265100 beats per minute, or a respiratory rate of >20 breaths per minute). Patients were randomly assigned to undergo ultrasound-facilitated, catheter-directed fibrinolysis with alteplase plus anticoagulation (the intervention group) or anticoagulation alone (the control group) according to prespecified treatment protocols. The primary outcome was a composite of pulmonary embolism\u2013related death, cardiorespiratory decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days.<\/p>\n\n\n\n

RESULTS<\/h3>\n\n\n\n

The intention-to-treat population comprised 544 patients: 273 in the intervention group and 271 in the control group. The mean (\u00b1SD) age was 58.2\u00b113.5 years, and 42.6% of the patients were women. A primary-outcome event occurred in 11 patients (4.0%; 95% confidence interval [CI], 2.3 to 7.1) in the intervention group and 28 (10.3%; 95% CI, 7.2 to 14.5) in the control group (relative risk, 0.39; 95% CI, 0.20 to 0.77; P=0.005). The effect was driven primarily by a lower risk of cardiorespiratory decompensation or collapse in the intervention group. Major bleeding occurred within 7 days after randomization in 11 patients (4.1%) in the intervention group and 6 (2.2%) in the control group (P=0.32); major bleeding occurred within 30 days in 11 patients (4.1%) and 8 patients (3.0%), respectively (P=0.64). No substantial between-group differences in the incidence of other serious adverse events were observed up to 30 days after randomization; no intracranial hemorrhage occurred.<\/p>\n\n\n\n

\"\"<\/a><\/figure>\n\n\n\n
\"\"<\/a><\/figure>\n\n\n\n
\"\"<\/a><\/figure>\n\n\n\n
\"\"<\/a><\/figure>\n\n\n\n
\"\"<\/a><\/figure>\n\n\n\n

CONCLUSIONS<\/h3>\n\n\n\n

In patients with acute, intermediate-risk pulmonary embolism, ultrasound-facilitated, catheter-directed fibrinolysis plus anticoagulation led to a lower risk of the composite of pulmonary embolism\u2013related death, cardiopulmonary decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days than anticoagulation alone. (Funded by Boston Scientific; HI-PEITHO ClinicalTrials.gov number, NCT04790370<\/a>.)<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Ultrasound-Facilitated, Catheter-Direc […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30608"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30608"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30608\/revisions"}],"predecessor-version":[{"id":30622,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30608\/revisions\/30622"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30608"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30608"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30608"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}