{"type":"video","version":"1.0","html":"<iframe src=\"https://www.loom.com/embed/c6106815982e45f1a14f7fa38517c179\" frameborder=\"0\" width=\"1950\" height=\"1462\" webkitallowfullscreen mozallowfullscreen allowfullscreen></iframe>","height":1462,"width":1950,"provider_name":"Loom","provider_url":"https://www.loom.com","thumbnail_height":1462,"thumbnail_width":1950,"thumbnail_url":"https://cdn.loom.com/sessions/thumbnails/c6106815982e45f1a14f7fa38517c179-ee137da2a48799cf.gif","duration":1748.185,"title":"PRAGUE 26 Trial Catheter Thrombolysis Review","description":"Catheter-directed thrombolysis reduced the 7-day composite of death, recurrent pulmonary embolism, or cardiorespiratory decompensation or collapse from 6.8% to 0.7% (RR 0.10, 95% CI 0.02–0.44). The absolute risk reduction was 6.1 percentage points, which translates to a number needed to treat of roughly 17.\n\nThe result was driven mainly by fewer episodes of cardiorespiratory decompensation, not a proven reduction in mortality. The trial was open-label, the adjudicators knew treatment assignment, and part of the decompensation definition relied on a National Early Warning Score threshold.\n\nBleeding rates were similar overall, but two patients in the thrombolysis group had an intracranial hemorrhage. That is the tension at the center of this trial: catheter-directed alteplase appears to prevent early deterioration, but the benefit has to be weighed against a rare and potentially devastating harm.\n\nFor carefully selected patients with intermediate-high–risk PE at experienced centers, PRAGUE-26 lowers the threshold for an early PERT discussion. It does not justify routine catheter-directed thrombolysis for everyone with RV strain and a positive troponin."}