The net benefit of thrombolysis in the management of intermediate risk pulmonary embolism: Systematic review and meta‐analysis
Background Benefit of thrombolytic therapy in patients with massive pulmonary embolism (PE) is evident. However, evidence supporting benefit in clinical outcomes of this approach in intermediate risk PE is lacking. Objective To determine the impact of thrombolysis on overall survival in intermediate...
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Published in | EJHaem Vol. 1; no. 2; pp. 457 - 466 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
United States
John Wiley and Sons Inc
01.11.2020
Wiley |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Benefit of thrombolytic therapy in patients with massive pulmonary embolism (PE) is evident. However, evidence supporting benefit in clinical outcomes of this approach in intermediate risk PE is lacking.
Objective
To determine the impact of thrombolysis on overall survival in intermediate risk PE patients.
Methods
We searched in MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from present day. We also searched in other databases and unpublished literature. We included clinical trials without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. The primary outcome was overall survival. Secondary outcomes were adverse events, including major bleeding, and all‐cause mortality. The measure of the effect was the risk ratio with a 95% confidence interval (CI).
Results
We included 11 studies in the qualitative and quantitative analysis, with a total of 1855 patients. Risk of bias was variable among the study items. There were no results reported about overall survival in any of the studies. The risk ratio (RR) for all‐cause mortality was 0.68 95% CI (0.40 to 1.16). The RR of overall bleeding, major bleeding and stroke were 2.72 95% CI (1.58 to 4.69), 2.17 95% CI (1.03 to 4.55), and 2.22 95% CI (0.17 to 28.73), respectively. Additionally, the RR for recurrent PE was 0.56 95% CI (0.23 to 1.37).
Conclusions
In patients with intermediate risk PE, the risk of bleeding is higher when thrombolysis is used. There was no significant difference between thrombolysis and anticoagulation in recurrence of PE, stroke, and all‐cause mortality. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 2688-6146 2688-6146 |
DOI: | 10.1002/jha2.97 |