PRAGUE-26 found that catheter-directed thrombolysis substantially reduced short-term clinical deterioration compared with anticoagulation alone in patients with intermediate–high-risk pulmonary embolism.
Catheter-directed thrombolysis (CDT) significantly reduced short-term adverse clinical events in patients with intermediate–high-risk pulmonary embolism (PE), according to findings from the PRAGUE-26 trial presented at ESC Congress 2026.
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Current management of intermediate–high-risk PE generally involves anticoagulation, with escalation of treatment if hemodynamic deterioration occurs. PRAGUE-26 investigated whether earlier catheter-based delivery of thrombolytic therapy could improve outcomes.
The investigator-led trial enrolled 558 patients across 11 centers in Czechia. Participants were randomized to conventional CDT or standard anticoagulation alone.
Within 7 days, the composite primary endpoint of all-cause mortality, recurrent PE, or cardiorespiratory decompensation or collapse occurred in 0.7% of patients receiving CDT compared with 6.8% receiving standard care (RR 0.10; 95% CI 0.02–0.44; p<0.001).
The difference was driven predominantly by a reduction in cardiorespiratory decompensation or collapse.
Overall bleeding rates were similar between the two groups, occurring in 4.6% of patients receiving CDT and 5.0% receiving standard care over 7 days. However, two intracranial bleeding events occurred in the CDT group compared with none in the standard-care group.
The findings suggest that CDT may help prevent early clinical deterioration in appropriately selected patients with intermediate–high-risk PE. Further evidence will be important to determine how these results influence patient selection and future treatment recommendations.
Reference
Presentation: Viktor Kočka. Prague 26: catheter-directed thrombolysis for pulmonary embolism. Presented during Hot Line 12 at ESC Congress 2026; August 31, 2026; Munich, Germany.
Cite: Catheter-directed thrombolysis reduces early clinical deterioration in pulmonary embolism. touchCARDIO. September 2, 2026.
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Editor: Nicola Cartridge, Director of Content
touchCARDIO coverage of ESC Congress 2026: This content has been developed independently by Touch Medical Media for touchCARDIO. It is not affiliated with the ESC. Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
