{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T06:51:01Z","timestamp":1793947861764,"version":"4.8.0"},"reference-count":24,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2022,12,1]]},"abstract":"\n Importance<\/jats:title>\n The optimal treatment of intermediate-high\u2013risk pulmonary embolism (PE) remains unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the effect of conventional catheter-directed thrombolysis (cCDT) plus anticoagulation vs anticoagulation monotherapy in improving echocardiographic measures of right ventricle (RV) to left ventricle (LV) ratio in acute intermediate-high\u2013risk PE.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n The Catheter-Directed Thrombolysis vs Anticoagulation in Patients with Acute Intermediate-High\u2013Risk Pulmonary Embolism (CANARY) trial was an open-label, randomized clinical trial of patients with intermediate-high\u2013risk PE, conducted in 2 large cardiovascular centers in Tehran, Iran, between December 22, 2018, through February 2, 2020.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Patients were randomly assigned to cCDT (alteplase, 0.5 mg\/catheter\/h for 24 hours) plus heparin vs anticoagulation monotherapy.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The proportion of patients with a 3-month echocardiographic RV\/LV ratio greater than 0.9, assessed by a core laboratory, was the primary outcome. The proportion of patients with an RV\/LV ratio greater than 0.9 at 72 hours after randomization and the 3-month all-cause mortality were among secondary outcomes. Major bleeding (Bleeding Academic Research Consortium type 3 or 5) was the main safety outcome. A clinical events committee, masked to the treatment assignment, adjudicated clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study was prematurely stopped due to the COVID-19 pandemic after recruiting 94 patients (mean [SD] age, 58.4\u2009[2.5] years; 27 women [29%]), of whom 85 patients completed the 3-month echocardiographic follow-up. Overall, 2 of 46 patients (4.3%) in the cCDT group and 5 of 39 patients (12.8%) in the anticoagulation monotherapy group met the primary outcome (odds ratio [OR], 0.31; 95% CI, 0.06-1.69;\n P<\/jats:italic>\n \u2009=\u2009.24). The median (IQR) 3-month RV\/LV ratio was significantly lower with cCDT (0.7 [0.6-0.7]) than with anticoagulation (0.8 [0.7-0.9);\n P<\/jats:italic>\n \u2009=\u2009.01). An RV\/LV ratio greater than 0.9 at 72 hours after randomization was observed in fewer patients treated with cCDT (13 of 48 [27.0%]) than anticoagulation (24 of 46 [52.1%]; OR, 0.34; 95% CI, 0.14-0.80;\n P<\/jats:italic>\n \u2009=\u2009.01). Fewer patients assigned to cCDT experienced a 3-month composite of death or RV\/LV greater than 0.9 (2 of 48 [4.3%] vs 8 of 46 [17.3%]; OR, 0.20; 95% CI, 0.04-1.03;\n P<\/jats:italic>\n \u2009=\u2009.048). One case of nonfatal major gastrointestinal bleeding occurred in the cCDT group.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This prematurely terminated randomized clinical trial of patients with intermediate-high\u2013risk PE was hypothesis-generating for improvement in some efficacy outcomes and acceptable rate of major bleeding for cCDT compared with anticoagulation monotherapy and provided support for a definitive clinical outcomes trial.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05172115<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamacardio.2022.3591","type":"journal-article","created":{"date-parts":[[2022,10,19]],"date-time":"2022-10-19T11:07:31Z","timestamp":1666177651000},"page":"1189","source":"Crossref","is-referenced-by-count":141,"title":["Catheter-Directed Thrombolysis vs Anticoagulation in Patients With Acute Intermediate-High\u2013risk Pulmonary 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