ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Thrombosis and Haemostasis
This article is part of the Research TopicAdvancements in Understanding and Managing Pulmonary Thromboembolism and HypertensionView all 6 articles
A Comparative Study of Anticoagulation Combined with Different Catheter-Directed Thrombolysis Strategies (Urokinase Catheter-Directed vs. Alteplase Infusion) in the Treatment of Intermediate-Risk Pulmonary Embolism
Provisionally accepted
Jinqi Huang
Qihong Chen*- The First Hospital of Putian City, Putian, China
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Objective: To compare the clinical efficacy and safety of anticoagulation combined with catheter-directed urokinase (UK) thrombolysis versus anticoagulation combined with catheter-directed alteplase (rt-PA) infusion thrombolysis in patients with intermediate-risk acute pulmonary embolism (APE). Methods: A retrospective analysis was conducted on intermediate-risk APE patients treated at our center between June 2022 and May 2025, all of whom received anticoagulation combined with catheter-directed thrombolysis. The UK group (n=56) received continuous UK infusion via pulmonary artery catheter (400,000–500,000 IU/day for 2–3 days), while the rt-PA group (n=23) received intraprocedural rt-PA infusion (20 mg/30 min). Changes in cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), right ventricular diameter/left ventricular diameter (RVD/LVD), and pulmonary artery obstruction index (PAOI) were compared before and after treatment. Results: Baseline characteristics showed no significant differences between groups (P > 0.05). Post-treatment, the UK group demonstrated significant improvements in PAOI, RVD/LVD, NT-proBNP, and cTnI (P < 0.05), while the rt-PA group showed significant improvements in PAOI, RVD/LVD, and cTnI (P < 0.05) but not NT-proBNP (P = 0.088). There were no statistically significant differences in the aforementioned indicators between the two groups at both pre-treatment and post-treatment time points (P > 0.05). There were no statistically significant differences in in-hospital mortality, the incidence of bleeding adverse events, and hospital stay duration between the two groups (P > 0.05). Conclusion: For intermediate-risk APE, catheter-directed UK thrombolysis and intraprocedural rt-PA infusion offer comparable efficacy and safety. However, the rt-PA regimen may be more advantageous due to its avoidance of prolonged catheter placement.
Keywords: Acute pulmonary embolism, alteplase, Catheter-directed thrombolysis, Efficacy Comparison, Intermediate-risk, Urokinase
Received: 29 Jul 2025; Accepted: 01 Dec 2025.
Copyright: © 2025 Huang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qihong Chen
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