2022 CANARY TRIAL Catheter-directed thrombolysis vs anticoagulation in patients with acute intermediate-high-risk pulmonary embolism parallel, open-label, randomized controlled trial Objective: To assess the effectiveness of catheter-directed thrombolysis (CCDT) compared with anticoagulation among intermediate- to high-risk individuals with acute pulmonary embolism 94 patients Inclusion criteria: Patients ≥18 years with acute pulmonary embolism presenting within 14 days and simplified pulmonary embolism severity index score ≥1 VS Catheter-directed thrombolysis group (n=48) Anticoagulation group (n=46) 4.3 PRIMARY OUTCOME % patients with 3-month echocardiographic RV/LV ratio >0.9 OR 0.31; 95% CI, 0.06 to 1.69; P=0.24 SECONDARY OUTCOMES % patients with an RV/LV ratio >0.9 at 72 hours 27.0 OR 0.34; 95% CI, 0.14 to 0.80; P=0.01 12.8 52.1 4.3 3-month composite of death or RV/LV >0.9 % OR 0.20; 95% CI, 0.04 to 1.03; P=0.048 17.3 Conclusion: This randomized clinical trial of patients with intermediate-high-risk pulmonary embolism was hypothesis-generating for improvement in some efficacy outcomes and acceptable rate of major bleeding for CCDT compared with anticoagulation monotherapy and provided support for a definitive clinical outcomes trial P Sadeghipour et al. doi:10.1001/jamacardio.2022.3591