Catheter-Directed Thrombolysis in Intermediate-High-Risk Pulmonary Embolism.

August 31, 2026| Source: The New England journal of medicine

Whether catheter-directed thrombolysis improves clinical outcomes in patients with intermediate-high-risk pulmonary embolism, as compared with anticoagulation alone, is uncertain. In this multicenter, open-label, randomized trial, we randomly assigned patients with intermediate-high-risk acute pulmonary embolism (defined by hemodynamic stability, a simplified Pulmonary Embolism Severity Index score of ≥1, and right ventricular dysfunction plus an elevated level of cardiac troponin or natriuretic peptide) in a 1:1 ratio to receive catheter-directed thrombolysis with alteplase plus anticoagulation therapy (thrombolysis group) or anticoagulation therapy alone (standard-care group). The primary outcome was a composite of death from any cause, recurrence of pulmonary embolism, or cardiorespiratory decompensation or collapse within 7 days after randomization. Secondary outcomes included clinically relevant bleeding as defined by the Bleeding Academic Research Consortium, major bleeding as defined in the Global Use of Strategies to Open Occluded Coronary Arteries guidelines, and intracranial hemorrhage. A total of 558 patients underwent randomization; 280 were assigned to the thrombolysis group, and 278 to the standard-care group. The median age was 64 years, and 40.9% were female. A primary-outcome event occurred in 2 patients (0.7%) in the thrombolysis group and in 19 patients (6.8%) in the standard-care group (relative risk, 0.10; 95% confidence interval, 0.02 to 0.44; P<0.001); this difference was driven mainly by the lower incidence of cardiorespiratory decompensation or collapse in the thrombolysis group. By day 7, clinically relevant bleeding had occurred in 13 patients (4.6%) in the thrombolysis group and in 14 patients (5.0%) in the standard-care group (P = 0.85); major bleeding in 4 (1.4%) and 6 (2.2%), respectively (P = 0.54); and intracranial hemorrhage in 2 (0.7%) and none. One patient in the thrombolysis group died within 30 days, and 4 patients in the standard-care group died within 7 days. Among patients with intermediate-high-risk acute pulmonary embolism, catheter-directed thrombolysis with alteplase plus anticoagulation therapy led to a lower risk of death from any cause, recurrent pulmonary embolism, or cardiorespiratory decompensation or collapse within 7 days after randomization than anticoagulation therapy alone. (Funded by the Ministry of Health of the Czech Republic and others; PRAGUE-26 ClinicalTrials.gov number, NCT05493163; EudraCT number, 2022-002218-18; European Union Clinical Trials number, 2024-516144-25-00.).

Read the original source →

Multiband condensate of magnons in two dimensions.

Wavelike bosonic particles can accumulate in a single mode characterized by a particular wavelength, and such condensates are at the heart of phenomena such as superconductivity and superfluidity where usually a single complex number describes their state. If there are several flavors of excitations or particles, a vector containing several complex numbers can characterize multicomponent condensation, thus opening new possibilities for textures, dynamics, and devices. Thus far, multicomponent co

Indirect reciprocity with dual private assessment.

People often cooperate out of concern for their reputation. The corresponding theory of indirect reciprocity predicts that such cooperation can only evolve if people's opinions of each other are sufficiently correlated. This correlation, however, can be difficult to achieve when individuals form their opinions independently from one another, as in private assessment models. In that case, errors can generate disagreements that propagate throughout a population. Here, we identify a simple mechanis

A genetic program for rapid initiation of axillary meristems at the onset of flowering.

Shoot branching patterns and their diversity arise from variable activities of axillary meristems (AMs). A common feature of flowering plants is delayed AM initiation and growth during the vegetative phase, followed by a sudden and rapid acceleration of apical AM initiation during the reproductive phase. The mechanisms underlying this pronounced developmental shift are poorly understood. During tomato floral transition, the primary shoot meristem (PSM) terminates in a flower after producing two

David Botstein: A pioneering geneticist and educator 1942-2026.

David Botstein, who died on February 27, 2026, was a towering figure in the field of modern molecular genetics. His research career was largely focused on the development of methods to better understand biological systems, beginning with his early work on Salmonella phage P22 and yeast, where he exploited the use of conditional lethal mutations as suppressors to identify genes with common functions and to order them in a pathway. He is best remembered for developing restriction fragment length p

Ultra-narrowband organic room-temperature phosphorescence achieved by boosting low-frequency vibronic coupling.

We pioneered a strategy based on low-frequency vibronic coupling to design narrowband room-temperature phosphorescent (RTP) materials. Here we select coronene derivative (CoDe) system and report that attaching aroyl group to the coronene core disrupts its intrinsic symmetry and introduces abundant low-frequency vibrational modes, thereby affording efficient room-temperature phosphorescence with a full width at half maximum (FWHM) of approximately 25 nm or narrower. In CoDe systems functionalized