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Reduced-Dose Thrombolysis in Intermediate-Risk Pulmonary Embolism With High-Risk Features (REDUCTION)

2 novembre 2026 mis à jour par: China National Center for Cardiovascular Diseases

Reduced-Dose Thrombolysis in Intermediate-High Risk Pulmonary Embolism, a Multicenter, Randomized Controlled Trial

Alteplase, a recombinant tissue plasminogen activator (rt-PA), is commonly used for thrombolytic treatment in patients with high-risk acute pulmonary thromboembolism (PTE), whereas the role of thrombolysis in intermediate-risk PTE remains controversial. This multicenter, randomized controlled trial will compare the efficacy and safety of reduced-dose alteplase (25 mg administered intravenously over 2 hours) plus standard anticoagulation with standard anticoagulation alone in patients with intermediate-risk PTE who have high-risk features.

Aperçu de l'étude

Statut

Pas encore de recrutement

Les conditions

Intervention / Traitement

Description détaillée

In patients with intermediate-risk pulmonary embolism (PE), full-dose systemic thrombolysis has been associated with a reduction in the risk of hemodynamic decompensation but an increased risk of major and intracranial bleeding. Previous studies suggest that reduced-dose thrombolysis may improve right ventricular (RV) function while potentially reducing bleeding complications. However, evidence regarding the efficacy and safety of reduced-dose systemic thrombolysis in patients with intermediate risk PE and additional high-risk clinical features remains limited. This study aims to evaluate the efficacy and safety of reduced-dose thrombolytic therapy in this patient population.

The REDUCTION study is a multicenter, randomized, open-label, controlled trial with blinded endpoint assessment and long-term follow-up.

Eligible patients will be randomly assigned in a 1:1 ratio to receive reduced-dose alteplase combined with standard anticoagulation or standard anticoagulation alone. Randomization will be centrally managed and stratified by participating center.

Patients will receive:

  • Reduced-dose alteplase group: Alteplase 25 mg administered by intravenous infusion over 2 hours, followed by standard anticoagulation with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) for at least 5 days.
  • Standard anticoagulation group: Standard anticoagulation with LMWH or UFH for at least 5 days without thrombolytic therapy.

The primary objective is to assess the efficacy of reduced-dose alteplase in improving RV function at 48 hours, as measured by the change in the ratio of right ventricular to left ventricular end-diastolic diameters (RVED/LVED) on echocardiography.

The secondary objectives are to evaluate early changes in right ventricular function, clinical deterioration, PE-related mortality, recurrent PE, and bleeding complications. Long-term assessments will evaluate persistent dyspnea, functional status, persistent right ventricular dysfunction, and the occurrence of chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH)

Type d'étude

Interventionnel

Inscription (Estimé)

270

Phase

  • Phase 3

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Coordonnées de l'étude

  • Nom: Changming Xiong, Prof.
  • Numéro de téléphone: (+86)010-88396798
  • E-mail: xiongcmfw@163.com

Lieux d'étude

      • Beijing, Chine, 100037
        • Chinese Academy of Medical Sciences, Fuwai Hospital
        • Contact:
          • Changming Xiong, Prof.
          • Numéro de téléphone: 010-88396798
          • E-mail: xiongcmfw@163.com
    • Beijing Municipality
      • Beijing, Beijing Municipality, Chine, 100029
        • China-Japan Friendship Hospital
        • Contact:
      • Beijing, Beijing Municipality, Chine, 100730
        • Peking Union Medical College Hospital
        • Contact:
          • Juhong Shi, Prof.
          • Numéro de téléphone: 010-69156114
          • E-mail: shijh@pumch.cn
      • Beijing, Beijing Municipality, Chine, 100029
        • Beijing Anzhen Hospital, Capital Medical University
        • Contact:
      • Beijing, Beijing Municipality, Chine, 100020
        • Beijing ChaoYang Hospital.Capital Medical University
        • Contact:
          • Yuanhua Yang, Prof.
          • Numéro de téléphone: 010-85231777
          • E-mail: yyh1031@sina.com
    • Guangdong
      • Guangzhou, Guangdong, Chine, 510120
        • Guangdong Provincial Hospital of Chinese Medicine
        • Contact:
          • Yinji Xu, Prof.
          • Numéro de téléphone: 020-81887233
          • E-mail: xuyinji@163.com
      • Guangzhou, Guangdong, Chine, 510120
        • The First Affiliated Hospital of Guangzhou Medical University / Guangzhou Institute of Respiratory Health (National Clinical Research Center for Respiratory Disease)
        • Contact:
      • Shenzhen, Guangdong, Chine, 518116
        • Longgang Central Hospital of Shenzhen
        • Contact:
          • Siliang Xu, Prof.
          • Numéro de téléphone: 0755-84806933
          • E-mail: 420814562@qq.com
    • Hebei
      • Zhangjiakou, Hebei, Chine, 075000
        • The First Affiliated Hospital of Hebei North University
        • Contact:
    • Henan
      • Xinxiang, Henan, Chine, 453400
        • HeNan Honliv Hospital
        • Contact:
          • Lei Yang, Prof.
          • Numéro de téléphone: 0373-8882288
          • E-mail: 61194255@qq.com
      • Zhengzhou, Henan, Chine, 450052
        • The First Affiliated Hospital of Zhengzhou University
        • Contact:
      • Zhengzhou, Henan, Chine, 450003
        • Henan Provincial People's Hospital
        • Contact:
    • Hubei
      • Wuhan, Hubei, Chine, 430015
        • Wuhan Sixth Hospital (Affiliated Hospital of Jianghan University)
        • Contact:
          • Fajiu Li, Prof.
          • Numéro de téléphone: 027-82426502
          • E-mail: 80670519@qq.com
    • Inner Mongolia
      • Baotou, Inner Mongolia, Chine, 014010
        • Inner Mongolia Baogang Hospital
        • Contact:
      • Tongliao, Inner Mongolia, Chine, 028000
        • NMG Keerqin District Hosp.
        • Contact:
          • Xili Wang, Prof.
          • Numéro de téléphone: 0475-8232510
          • E-mail: 861004223@qq.com
    • Jiangsu
      • Changzhou, Jiangsu, Chine, 213003
        • The Second People's Hospital of Changzhou, The Third Affiliated Hospital of Nanjing Medical University
        • Contact:
      • Nanjing, Jiangsu, Chine, 210006
        • Nanjing First Hospital
        • Contact:
          • He Xu, Prof.
          • Numéro de téléphone: 025-52271000
          • E-mail: hexunj@163.com
    • Liaoning
      • Shenyang, Liaoning, Chine, 110024
        • Central Hospital Affiliated to Shenyang Medical College
        • Contact:
          • Shuyue Xia, Prof.
          • Numéro de téléphone: 024-85715200
          • E-mail: syx262@126.com
      • Shenyang, Liaoning, Chine, 110003
        • General Hospital of Northern Theater Command
        • Contact:
    • Ningxia
      • Yinchuan, Ningxia, Chine, 750004
        • Ningxia Medical University General Hospital
        • Contact:
    • Shandong
      • Jinan, Shandong, Chine, 250021
        • Shandong Provincial Hospital
        • Contact:
      • Linyi, Shandong, Chine, 276000
        • Linyi People's Hospital
        • Contact:
    • Shanghai Municipality
      • Shanghai, Shanghai Municipality, Chine, 200120
        • Shanghai East Hospital, School of Medicine, Tongji University
        • Contact:
    • Sichuan
      • Chengdu, Sichuan, Chine, 610041
        • West China Hospital, Sichuan University
        • Contact:
    • Tianjin Municipality
      • Tianjin, Tianjin Municipality, Chine, 300052
        • Tianjin Medical University General Hospital
        • Contact:
      • Tianjin, Tianjin Municipality, Chine, 300222

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

18 ans à 75 ans (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria:

  • Age 18 to 75 years

  • Objectively confirmed acute pulmonary thromboembolism (PTE) with symptom onset within 14 days, based on at least one of the following:

    1. Ventilation/perfusion lung scan showing at least one segmental or larger mismatched perfusion defect;
    2. Computed tomography pulmonary angiography (CTPA) or pulmonary angiography showing a filling defect or abrupt obstruction in a segmental or more proximal pulmonary artery.
  • Intermediate-high-risk PTE, with both of the following:

    1. Right ventricular dysfunction (RVD) on echocardiography or CTPA. Echocardiographic RVD is defined by at least one of the following:(1) right ventricular dilation with RV/LV end-diastolic diameter ratio >1.0; (2) reduced right ventricular free-wall motion; (3) increased tricuspid regurgitation velocity;(4) tricuspid annular plane systolic excursion <16 mm; (5) tricuspid annular systolic velocity (S') <9.5 cm/s. CTPA evidence of RVD is defined as right ventricular dilation with RV/LV end-diastolic diameter ratio >1.0.
    2. Cardiac injury or heart failure biomarker above the local upper limit of normal, including cardiac troponin, BNP, or NT-proBNP.
  • Elevated risk of early death/hemodynamic collapse, indicated by at least one of the following high-risk features: Systolic blood pressure ≤110 mmHg, Heart rate ≥100 beats/min, Oxygen saturation (SpO₂) <90% (respiratory rate >20 breaths/min or arterial partial pressure of oxygen [PaO₂] <60 mmHg).

  • Signed informed consent

Exclusion Criteria:

  • High-risk PTE with hemodynamic instability, including cardiac arrest, obstructive shock, or persistent hypotension defined as systolic blood pressure <90 mmHg or a decrease of ≥40 mmHg from baseline lasting at least 15 minutes, after excluding hypotension caused by new-onset arrhythmia, hypovolemia, or sepsis.

  • Intermediate-low-risk PTE, defined as hemodynamically stable PE with only one of the following findings: right ventricular dysfunction on imaging or elevated cardiac biomarkers.

  • Low-risk PTE, defined as hemodynamically stable PTE without right ventricular dysfunction and without elevated cardiac injury or heart failure biomarkers.

  • Any contraindication to systemic thrombolysis, including:

    1. Known hypersensitivity to alteplase, gentamicin, heparin, low-molecular-weight heparin, or any component of the study treatment;
    2. Active bleeding or high risk of bleeding;
    3. Known or suspected intracranial hemorrhage;
    4. Suspected subarachnoid hemorrhage or aneurysmal subarachnoid hemorrhage;
    5. Significant bleeding disorder within the previous 6 months;
    6. Known bleeding diathesis;
    7. Acute ischemic stroke or transient ischemic attack within the previous 6 months;
    8. Ophthalmic surgery within the previous 3 months, or abdominal, cardiac, thoracic, vascular, or orthopedic surgery or trauma within the previous 3 months;
    9. History of central nervous system disease or trauma, including tumor, aneurysm, head trauma, intracranial surgery, or spinal surgery;
    10. Platelet count <100 × 10^9/L;
    11. International normalized ratio (INR) >1.3;
    12. Current effective oral anticoagulant treatment;
    13. Traumatic cardiopulmonary resuscitation;
    14. Infective endocarditis or pericarditis;
    15. Acute pancreatitis;
    16. Noncompressible vascular puncture;
    17. Severe uncontrolled hypertension, with systolic blood pressure >180 mmHg and/or diastolic blood pressure >110 mmHg;
    18. Any other condition considered by the investigator to confer a high bleeding risk;
    19. Severe liver disease, including liver failure, cirrhosis, portal hypertension, esophageal varices, or active hepatitis;
    20. Gastrointestinal ulcer, esophageal varices, arterial aneurysm, or arteriovenous malformation within the previous 3 months;
    21. Tumor with bleeding tendency;
    22. Pregnancy or within 1 week postpartum;
    23. Diabetes with hemorrhagic retinopathy;
  • Body weight ≤40 kg.

  • Thrombolytic treatment within 30 days before randomization for the current episode of acute PE, including systemic or catheter-directed thrombolysis.

  • Catheter-directed mechanical thrombectomy or surgical pulmonary embolectomy before randomization for the current episode of acute PE.

  • Use of any direct oral anticoagulant within 30 days before randomization.

  • Current dual antiplatelet therapy.

  • Current participation in another interventional clinical trial.

  • Women of childbearing potential who are unwilling to use effective contraception or abstinence during the study.

  • Any other disease or condition that, in the investigator's judgment, would increase treatment risk.

  • Life expectancy <3 months or inability to complete 3-month follow-up.

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Seul

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Comparateur actif: Reduced-Dose Alteplase and Standard Anticoagulation

Low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) and reduced-dose alteplase [25 mg continuous intravenous infusion for 2 hours]

Alteplase 25 mg will be administered by continuous intravenous infusion over 2 hours

Standard anticoagulation will consist of LMWH or UFH administered according to current guideline recommendations for at least 5 days

Comparateur actif: Standard Anticoagulation

Low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH)

Standard anticoagulation will consist of LMWH or UFH administered according to current guideline recommendations for at least 5 days

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Délai
Change in the ratio of right ventricular end-diastolic diameter to left ventricular end-diastolic diameter (RVED/LVED) as measured by echocardiography
Délai: Between baseline and 48 hours
Between baseline and 48 hours

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Change in the ratio of right ventricular end-diastolic diameter to left ventricular end-diastolic diameter (RVED/LVED) as measured by echocardiography
Délai: Between baseline and 7 days
Between baseline and 7 days
Clinical Deterioration
Délai: 7 days
7 days
PE-Related Death
Délai: 7 days

Death caused by pulmonary embolism (PE)

7 days
All cause Death
Délai: 7 days
7 days
Recurrent PE
Délai: 7 days
7 days
Persistent Dyspnea
Délai: 6 months

Persistent Dyspnea Assessed by the Medical Research Council (MRC) Dyspnea Scale

6 months
Functional outcome
Délai: 6 months

Functional status will be assessed using the Post-Venous Thromboembolism Functional Status (PVFS) Scale, which measures limitations in usual activities and daily functioning after venous thromboembolism. The scale ranges from grade 0 (no functional limitations) to grade 4 (severe functional limitations requiring assistance with activities of daily living). Higher grades indicate greater functional impairment. Grade D indicates death before the scheduled assessment.

6 months
Persistent Right Ventricular Dysfunction
Délai: 6 months

Persistent right ventricular dysfunction is defined as an intermediate or high probability of pulmonary hypertension on echocardiography according to the European Society of Cardiology (ESC) criteria.

6 months
Chronic thromboembolic pulmonary disease (CTEPD) and/or Chronic thromboembolic pulmonary hypertension (CTEPH)
Délai: 12 months
12 months
Major bleeding
Délai: 30 days

Major bleeding will be defined according to the International Society on Thrombosis and Haemostasis (ISTH) criteria as fatal bleeding, symptomatic bleeding in a critical area or organ, a decrease in hemoglobin of ≥2 g/dL, or transfusion of ≥2 units of whole blood or red blood cells. The number of participants experiencing major bleeding will be recorded

30 days
Clinically relevant non-major bleeding
Délai: 30 days

Clinically relevant non-major bleeding will be defined according to ISTH criteria as bleeding that does not meet the criteria for major bleeding but requires medical intervention, leads to hospitalization or an increased level of care, or prompts a face-to-face evaluation by a healthcare professional. The number of participants experiencing clinically relevant non-major bleeding will be recorded.

30 days
Minor bleeding
Délai: 30 days

Minor bleeding will be defined as any overt bleeding event that does not meet the criteria for major bleeding or clinically relevant non-major bleeding and does not require medical attention. The number of participants experiencing minor bleeding will be recorded.

30 days

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

Les enquêteurs

  • Chercheur principal: Changming Xiong, Prof., Chinese Academy of Medical Sciences, Fuwai Hospital
  • Chercheur principal: Zhenguo Zhai, Prof., China-Japan Friendship Hospital

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Publications générales

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Estimé)

1 novembre 2026

Achèvement primaire (Estimé)

31 décembre 2028

Achèvement de l'étude (Estimé)

31 décembre 2029

Dates d'inscription aux études

Première soumission

15 octobre 2026

Première soumission répondant aux critères de contrôle qualité

2 novembre 2026

Première publication (Réel)

4 novembre 2026

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

4 novembre 2026

Dernière mise à jour soumise répondant aux critères de contrôle qualité

2 novembre 2026

Dernière vérification

1 octobre 2026

Plus d'information

Termes liés à cette étude

Autres numéros d'identification d'étude

  • 2026ZD0556203-02
  • 2026ZD0556203 (Autre subvention/numéro de financement: Noncommunicable Chronic Diseases-National Science and Technology Major Project)

Plan pour les données individuelles des participants (IPD)

Prévoyez-vous de partager les données individuelles des participants (DPI) ?

NON

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Non

Étudie un produit d'appareil réglementé par la FDA américaine

Non

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .