PRAGUE-26 Evaluates Interventional Strategy for PE in Intermediate–High-Risk Patients 

September 24, 2026—The PRAGUE-26 study, which is evaluating whether an interventional strategy can improve outcomes in patients with embolism, showed that catheter-directed thrombolysis (CDT) improved short-term clinical outcomes compared with standard anticoagulation therapy alone in patients with intermediate–high-risk pulmonary embolism (PE). The European Society of Cardiology (ESC) announced that the results were presented at the ESC congress 2026.

The study was led by Professor Viktor Kočka, MD, and Josef Kroupa, MD, from Charles University and University Hospital Kralovske Vinohrady in Prague, Czechia. The study was conducted at 11 sites in Czechia.

According to ESC, patients with acute intermediate−high risk PE (as defined by the 2019 ESC guidelines) were randomized (1:1) to CDT or standard anticoagulation therapy alone (intravenous unfractionated heparin or subcutaneous low molecular weight heparin). The study was composed of 558 patients with a median age of 64 years; 41% were women.

The primary endpoint was a composite of all-cause mortality, PE recurrence, or cardiorespiratory decompensation/collapse (defined according to prespecified criteria) within 7 days of randomization.

As reported by ESC, the primary endpoint was significantly reduced in the CDT group compared with the standard-care group (0.7% vs 6.8%; relative risk, 0.10; 95% CI, 0.02-0.44; P < .001). This difference was driven primarily by a lower rate of cardiorespiratory decompensation or collapse with CDT.

“The primary outcome finding was accompanied by early improvement in right ventricular strain on echocardiography, consistent with previous studies reporting favorable effects of CDT,” commented Dr. Kroupa in the press release.

Regarding safety, there was no apparent difference in bleeding events between the CDT group and the standard-care group within 7 days (4.6% vs 5.0%; P = .846), stated ESC.

Additionally, the press release advised that there were two cases of intracranial bleeding in the CDT group and none in the standard-care group. There were four deaths in the standard-care group within 7 days and one death in the CDT group within 30 days.

Prof. Kočka discussed the implications of the findings in the ESC press release.

“Using the blueprint already employed for heart attacks, we were able to demonstrate that specialized interventional treatment can be delivered in tertiary care centers across our national network,” stated Prof. Kočka. “This may pave the way for an improved, standardized approach to the treatment of pulmonary embolism, reducing the acute risks that patients face.”

Noting that new ESC guidelines on PE are expected to be published next year, he concluded, “We hope the results from our trial with CDT will help to inform future recommendations.”