Key result
Ultrasound-accelerated thrombolysis (USAT) was not proven superior to non-USAT catheter-directed methods for treating submassive and massive pulmonary embolism (mortality 4% vs 9%).
Why the study?
Does ultrasound-accelerated thrombolysis improve mortality compared to standard catheter-directed thrombolysis in patients with submassive and massive pulmonary embolism?
Meta-Analysis (n=700)
Does ultrasound-accelerated thrombolysis improve mortality compared to standard catheter-directed thrombolysis in patients with submassive and massive pulmonary embolism?
Current clinical evidence does not demonstrate that ultrasound-accelerated thrombolysis is superior to standard catheter-directed thrombolysis for treating submassive and massive pulmonary embolism.
Answers are grounded in this paper and cite their sources.
USAT shows no mortality benefit over standard CDT in PE; does not support preferential use and leaves open need for definitive RCTs.
We summarize the evidence for the safety and efficacy of catheter-directed thrombolysis (CDT) with and without ultrasound-assisted therapy for treating submassive and massive pulmonary embolism (PE) in a systematic review. The primary efficacy outcome was mortality. Outcomes were pooled across studies with the random-effects model. Twenty-four studies enrolled 700 patients in total; 653 received mechanical thromboembolectomy treatments for PE (mortality rate, 9% [95% confidence interval (CI), 6%-13%], P = .12; rate of minor complications, 6% [95% CI, 2%-13%]). In the ultrasound-accelerated thrombolysis (USAT) studies, the mortality rate was 4% (95% CI, 1%-11%) and in the non-USAT studies, it was 9% (95% CI, 6%-13%). Secondary safety outcomes were all bleeding events, which occurred in 12% (95% CI, 7%-20%) of the USAT studies and in 10% (95% CI, 5%-20%) of the non-USAT studies. Current clinical evidence does not prove USAT is superior over CDT methods.
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Tafur et al. (2016) conducted a meta-analysis in submassive and massive pulmonary embolism (PE) (n=700). Ultrasound-accelerated thrombolysis (USAT) vs. Catheter-directed thrombolysis (CDT) without ultrasound (non-USAT) was evaluated on mortality. Ultrasound-accelerated thrombolysis (USAT) was not proven superior to non-USAT catheter-directed methods for treating submassive and massive pulmonary embolism (mortality 4% vs 9%).
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