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Ben Creagh-Brown: How Should HI-PEITHO Influence the Management of Intermediate-Risk Pulmonary Embolism?
Ben Creagh-Brown/ LinkedIn
May 30, 2026, 08:58

Ben Creagh-Brown: How Should HI-PEITHO Influence the Management of Intermediate-Risk Pulmonary Embolism?

Ben Creagh-Brown, Consultant Physician at Royal Surrey County Hospital NHS Foundation Trust, shared a post on LinkedIn about a recent article by Kenneth Rosenfield et al. published in NEJM, adding:

“As an intensivist with a background in respiratory medicine, who works at a major cancer centre – I’m very interested in risk stratification and treatment for higher-risk pulmonary embolism (PE).

Thanks to my colleagues in interventional radiology we have access to 24/7 catheter-directed thrombolysis (CDT) for appropriate patients (mainly major PE with contraindication to systemic thrombolysis).

The HI-PEITHO trial was published in this week’s NEJM:

  • P (Population): 544 stable adults with acute, intermediate-risk PE showing signs of cardiorespiratory distress. (RV/LV ratio ≥1, elevated troponin)
  • I (Intervention): ultrasound-facilitated, catheter-directed fibrinolysis: US-CDF (alteplase (8.8mg unilateral / about 16.9mg bilateral) via EkoSonic system) and anticoagulation.
  • C (Comparison): Anticoagulation alone.
  • O (Outcomes)

Efficacy: US-CDF cut the 7-day composite risk of PE-related death, collapse, or recurrence by 61% (4.0% vs. 10.3%, P=0.005).

Safety: No statistical difference in 7-day major bleeding (4.1% vs. 2.2%) and 0% intracranial haemorrhage in both groups.

This potentially expands the possible uses of CDT to a broader group of patients.

The real question is – to what extent was the ultrasound really facilitating?

Does the application of thrombolysis via an appropriately placed catheter improve outcomes even if it’s not an EKOS catheter? I guess so, but IDK. What are your thoughts?”

Title: Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism

Authors: Kenneth Rosenfield, Frederikus A. Klok, Gregory Piazza, Andrew S.P. Sharp, Fionnuala Ní Áinle, Michael R. Jaff, Stefano Barco, Samuel Z. Goldhaber, Nils Kucher, Irene M. Lang, Irene Schmidtmann, Keith M. Sterling, Aleksander Araszkiewicz, Vishal Arora, Rafael Cires-Drouet, John Coghlan, Lukas Hobohm, Wulf D. Ito, Kurt Jacobson, Christoph Kaiser, Grzegorz Kopec, Kristin Marx, Samuel McElwee, Nicolas Meneveau, Peter Monteleone, Jose M. Montero-Cabezas, Christoph B. Olivier, John Park, Marek Roik, Rahul Sakhuja, Andi Tego, Markus Theurl, Gautam Visveswaran, Jan Albert Vos, Michael N. Young, Federico M. Asch, Stavros V. Konstantinides

Ben Creagh-Brown: How Should HI-PEITHO Influence the Management of Intermediate-Risk Pulmonary Embolism?

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Acute Pulmonary Embolism Aleksander Araszkiewicz Andi Tego Andrew S.P. Sharp Anticoagulation Ben Creagh-Brown Christoph B. Olivier Christoph Kaiser Federico M. Asch Fionnuala Ní Áinle Frederikus A Klok Gautam Visveswaran Gregory Piazza Grzegorz Kopec Health Hematology Hemostasis Hemostasis News Hemostasis Today Irene M. Lang Irene Schmidtmann Jan Albert Vos John Coghlan John Park Jose M. Montero-Cabezas Keith M. Sterling Kenneth Rosenfield Kristin Marx Kurt Jacobson Lukas Hobohm Marek Roik Markus Theurl Medicine Michael N. Young Michael R. Jaff NEJM Nicolas Meneveau Nils Kucher Peter Monteleone Rafael Cires-Drouet Rahul Sakhuja Samuel McElwee Samuel Z. Goldhaber Stavros V. Konstantinides Stefano Barco thrombosis Vishal Arora Wulf D. Ito
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