PRAGUE-26 trial shows catheter-directed thrombolysis improves pulmonary embolism outcomes

Results from the PRAGUE-26 randomized controlled trial, presented at the ESC Congress 2026, indicate that catheter-directed thrombolysis (CDT) improves short-term clinical outcomes for patients with intermediate-high risk pulmonary embolism compared to standard anticoagulation therapy alone.

Led by researchers from Charles University and University Hospital Kralovske Vinohrady in Prague, the study involved 558 patients across 11 sites in Czechia. Participants were randomized to receive either CDT with alteplase or standard anticoagulation, such as intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin. The primary endpoint measured a composite of all-cause mortality, pulmonary embolism recurrence, or cardiorespiratory decompensation within seven days of randomization.

Unlike some previous trials, this study utilized standard catheters to deliver thrombolytic medication rather than ultrasonic vibrational catheters. The findings address a significant unmet clinical need in pulmonary embolism treatment, where therapeutic advances have been limited over the last two decades.