Evidence map›Paper›PMID 42053874›Full record

ArticleIntensive care medicine experimental2026

Personalised viscoelastometry-guided systemic thrombolysis for high- and intermediate-high-risk acute pulmonary embolism in the ICU: a single-centre randomised controlled interventional feasibility trial.

András Kállai, Anna Párkányi, Máté Berczi, Dalma Skultéti, János Domonkos Stubnya, Hanna Dóra Szász, Gergely Szombath, Adrienne Fehér, Zsolt Dániel Iványi, János Gál and 1 more

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Article in Intensive care medicine experimental, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

András KállaiDepartment of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői Street 78/B, Budapest, H-1082, Hungary. kallai.andras@semmelweis.hu.ORCID http://orcid.org/0000-0002-1408-4634
Anna PárkányiDepartment of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői Street 78/B, Budapest, H-1082, Hungary.
Máté BercziDepartment of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői Street 78/B, Budapest, H-1082, Hungary.
Dalma SkultétiDepartment of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői Street 78/B, Budapest, H-1082, Hungary.
János Domonkos StubnyaDepartment of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői Street 78/B, Budapest, H-1082, Hungary.
Hanna Dóra SzászDepartment of Central Anesthesiology and Intensive Therapy, St. John's Central Hospital of North Buda, Budapest, Hungary.
Gergely SzombathDepartment of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary.
Adrienne FehérDepartment of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
Zsolt Dániel IványiDepartment of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői Street 78/B, Budapest, H-1082, Hungary.
János GálDepartment of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői Street 78/B, Budapest, H-1082, Hungary.
János FazakasDepartment of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői Street 78/B, Budapest, H-1082, Hungary.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSystemic thrombolysis is recommended for high-risk pulmonary embolism, but is associated with a substantial bleeding risk due to thrombolysis-induced coagulopathy. However, recent advances in precision and personalised care offer the potential to reduce mortality as well as the incidence of chronic thromboembolic pulmonary hypertension and post-pulmonary embolism impairment, thereby improving long-term outcomes. Our primary objective was to evaluate the feasibility of a viscoelastic testing-guided, low-dose, prolonged systemic thrombolysis protocol in acute pulmonary embolism. Exploratory secondary objectives included assessment of the safety and efficacy of the protocol using an individualised approach tailored to each patient's coagulation profile.

methodsThis single-centre, prospective, randomised interventional feasibility trial was conducted at Semmelweis University (Budapest, Hungary). Adult pulmonary embolism patients were randomly assigned to a control group (CG) receiving the ESC-recommended 100 mg/2 h dose of rtPA or a viscoelastometry-guided group (VGG), in which the rtPA dose and duration were adjusted based on viscoelastic tests. Transthoracic echocardiography (TTE) was performed every two hours to monitor right ventricular (RV) function and determine cessation of systemic thrombolysis in VGG. The primary outcome was feasibility; the secondary outcome was safety and efficacy.

resultsAmong 33 enrolled patients, 19 were included in the analysis (CG: 7; VGG: 12). Patients in the VGG received significantly lower doses of rtPA (median 32.00 mg [IQR 20.95-42.75 mg]) despite longer infusion duration (median 8.5 h [IQR 6.6-10.0]) and showed no coagulopathy. RV dysfunction persisted in two CG patients, whereas in the VGG it resolved in all patients. Major bleeding occurred in two patients in the CG and in one patient in the VGG.

conclusionsViscoelastometry-guided, individualised, low-dose systemic thrombolysis is feasible and supports a personalised approach to thrombolysis in the management of pulmonary embolism.

Indexed as

Feasibility studyPoint-of-care blood coagulation testsPrecision medicinePulmonary embolismThrombolytic therapy

Identifiers

PMID42053874
PMCPMC13129181

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.