Key result
Recanalisation procedures did not significantly reduce all-cause mortality compared with standard anticoagulation (e.g., full-dose thrombolysis OR 0.60; 95% CI 0.36-1.01).
Why the study?
Do recanalisation procedures reduce mortality compared to anticoagulant therapy in patients with acute symptomatic pulmonary embolism?
Meta-Analysis
Do recanalisation procedures reduce mortality compared to anticoagulant therapy in patients with acute symptomatic pulmonary embolism?
In acute symptomatic PE, recanalisation procedures do not significantly reduce mortality compared to standard anticoagulation, and full-dose thrombolysis increases the risk of major bleeding.
Answers are grounded in this paper and cite their sources.
No mortality benefit from recanalisation in acute PE; confirms anticoagulation alone for survival outcomes.
BACKGROUND: We aimed to review the efficacy and safety of recanalisation procedures for the treatment of PE. METHODS: We searched PubMed, the Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through 31 July 2015 and included randomised clinical trials that compared the effect of a recanalisation procedure versus each other or anticoagulant therapy in patients diagnosed with PE. We used network meta-analysis and multivariate random-effects meta-regression to estimate pooled differences between each intervention and meta-regression to assess the association between trial characteristics and the reported effects of recanalisation procedures versus anticoagulation. RESULTS: For all-cause mortality, there were no significant differences in event rates between any of the recanalisation procedures and anticoagulant treatment (full-dose thrombolysis: OR 0.60; 95% CI0.36 to 1.01; low-dose thrombolysis: 0.47; 95% CI 0.14 to 1.59; and catheter-associated thrombolysis: 0.31; 95% CI 0.01 to 7.96). Full-dose thrombolysis increased the risk of major bleeding (2.00; 95% CI 1.06 to 3.78) compared with anticoagulation. Catheter-directed thrombolysis was associated with the lowest probability of dying (surface under the cumulative ranking curve (SUCRA), 0.67), followed by low-dose thrombolysis (SUCRA, 0.66) and full-dose thrombolysis (SUCRA, 0.55). Similarly, low-dose thrombolysis was associated with the lowest probability of major bleeding (SUCRA, 0.61), followed by catheter-directed thrombolysis (SUCRA, 0.54) and full-dose thrombolysis (SUCRA, 0.17). The results were similar in sensitivity analyses based on restricting only to studies in haemodynamically stable patients with PE. CONCLUSIONS: In the treatment of PE, recanalisation procedures do not seem to offer a clear advantage compared with standard anticoagulation. Low-dose thrombolysis was associated with the lowest probability of dying and bleeding. TRIAL REGISTRATION NUMBER: PROSPERO CRD42015024670.
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Jiménez et al. (2017) conducted a meta-analysis in acute symptomatic pulmonary embolism. Recanalisation procedures (full-dose, low-dose, or catheter-associated thrombolysis) vs. Anticoagulant therapy was evaluated on All-cause mortality (OR 0.60, 95% CI 0.36 to 1.01). Recanalisation procedures did not significantly reduce all-cause mortality compared with standard anticoagulation (e.g., full-dose thrombolysis OR 0.60; 95% CI 0.36-1.01).
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