Yonah S. Tehrani: CDT vs Anticoagulation in Intermediate High Risk PE – The PRAGUE-26 Trial
Yonah S. Tehrani, Physician at Shaare Zedek Medical Center, Jerusalem, shared a post on LinkedIn:
“PRAGUE-26 (NEJM, Aug 31, 2026) tested a question most PE pathways still leave to local culture: in intermediate-high–risk pulmonary embolism, does catheter-directed thrombolysis change early outcomes versus anticoagulation alone?
In 558 randomized patients, the 7-day composite of death, recurrent PE, or cardiorespiratory decompensation fell from 6.8% to 0.7% (RR 0.10).
The signal was decompensation, not a large mortality difference.
Clinically relevant and major bleeding rates were similar; two intracranial hemorrhages occurred with CDT.
For health systems this is less a device story than an operations story.
Benefit only exists if PERT, IR/cath lab, and ICU can mobilize without delay – and if selection stays tight.
A 7-day, partly clinician-defined endpoint in an open-label trial should inform pathways, not automatic escalation.”
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