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July 20, 2004CirculationOpen Access

Thrombolysis Compared With Heparin for the Initial Treatment of Pulmonary Embolism

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Why the study?

Does thrombolytic therapy reduce recurrent pulmonary embolism or death compared to heparin in patients with acute pulmonary embolism?

Population

748 patients with acute pulmonary embolism from 11 randomized trials

Comparison

Thrombolytic therapy vs Heparin

Design

Meta-analysis

Authors

SWSusan WanRoyal Prince Alfred HospitalDQDaniel J. QuinlanKing's College HospitalGAGiancarlo AgnelliVascular Medicine

Discussion

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Implication

Does not support routine thrombolysis in unselected acute PE; confirms no significant overall benefit versus heparin.

Key Points

  • This research aims to compare the efficacy and safety of thrombolytic therapy with heparin in treating acute pulmonary embolism.
  • Conducted a meta-analysis of 11 randomized trials involving 748 patients.
  • Compared outcomes of thrombolytic therapy and heparin in reducing recurrent pulmonary embolism and death.
  • Analyzed major and nonmajor bleeding incidents.
  • Thrombolytic therapy had a nonsignificant reduction in recurrent pulmonary embolism or death (OR 0.67, 95% CI 0.40 to 1.12, P=0.48).
  • Significant increase in nonmajor bleeding events (22.7% vs. 10.0%; OR 2.63, 95% CI 1.53 to 4.54).
  • Benefit of thrombolytic therapy observed in high-risk patients (9.4% vs. 19.0%; OR 0.45, 95% CI 0.22 to 0.92; number needed to treat=10).

Structured PICO

Does thrombolytic therapy reduce recurrent pulmonary embolism or death compared to heparin in patients with acute pulmonary embolism?

P
Population
748 patients with acute pulmonary embolism from 11 randomized trials
I
Intervention
Thrombolytic therapy
C
Comparator
Heparin
O
Outcome
Composite of recurrent pulmonary embolism or deathcomposite

Thrombolytic therapy does not significantly reduce recurrent PE or death in unselected patients with acute PE compared to heparin, but may offer benefit in hemodynamically unstable patients.

Limitations

  • Modest number of patients enrolled in randomized trials to date

Cite This Study

Wan et al. (2004) studied this question.

synapsesocial.com/papers/6a198bec443d3ecd7cdebb62https://doi.org/10.1161/01.cir.0000137826.09715.9c

Topics

Pulmonary embolism
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Association Between Thrombolytic Treatment and the Prognosis of Hemodynamically Stable Patients With Major Pulmonary Embolism1997 · 462 citations
  2. 2Effect of Thrombolytic Therapy on Pulmonary-Capillary Blood Volume in Patients with Pulmonary Embolism1980 · 206 citations
  3. 3Comparison by Controlled Clinical Trial of Streptokinase and Heparin in Treatment of Life-threatening Pulmonary Embolism1974 · 279 citations
  4. 4Risks for Major Bleeding from Thrombolytic Therapy in Patients with Acute Pulmonary Embolism: Consideration of Noninvasive Management1994 · 90 citations
  5. 5Acute Pulmonary Embolism: Part II2003 · 142 citations