Key result
Catheter-directed therapy was associated with lower in-hospital mortality than systemic thrombolysis (OR 0.41; 95% CI 0.31-0.55), anticoagulation, and surgical embolectomy.
Why the study?
Multiple interventions exist for intermediate to high-risk pulmonary embolism, but the most effective and safest treatment remains unclear.
Does catheter-directed therapy improve mortality and bleeding outcomes compared to systemic thrombolysis, surgical embolectomy, or anticoagulation in patients with intermediate to high-risk pulmonary embolism?
Meta-Analysis (n=157,454)
Yes
Does catheter-directed therapy improve mortality and bleeding outcomes compared to systemic thrombolysis, surgical embolectomy, or anticoagulation in patients with intermediate to high-risk pulmonary embolism?
Odds Ratio: 0.41 (95% CI 0.31–0.55)
In patients with intermediate to high-risk pulmonary embolism, catheter-directed therapy is associated with lower in-hospital mortality and recurrent PE compared to systemic thrombolysis, surgical embolectomy, and anticoagulation, without increasing major bleeding.
Supports CDT preference in intermediate-high risk PE; extends comparative data across CDT, ST, SE, and AC.
BACKGROUND: Multiple interventions, including catheter-directed therapy (CDT), systemic thrombolysis (ST), surgical embolectomy (SE), and therapeutic anticoagulation (AC) have been used to treat intermediate to high-risk pulmonary embolism (PE), but the most effective and safest treatment remains unclear. Our study aimed to investigate the efficacy and safety outcomes of each intervention. METHODS: We queried PubMed and EMBASE in January 2023 and performed a network meta-analysis of observational studies and randomized controlled trials (RCT), including high or intermediate-risk PE patients, and comparing AC, CDT, SE, and ST. The primary outcomes were in-hospital mortality and major bleeding. The secondary outcomes included long-term mortality (≥6 months), recurrent PE, minor bleeding, and intracranial hemorrhage. RESULTS: We identified 11 RCTs and 42 observational studies involving 157,454 patients. CDT was associated with lower in-hospital mortality than ST (odds ratio [OR] [95% confidence interval (CI)]: 0.41 [0.31-0.55]), AC (OR [95% CI]: 0.33 [0.20-0.53]), and SE (OR [95% CI]: 0.61 [0.39-0.96]). Recurrent PE in CDT was lower than ST (OR [95% CI]: 0.66 [0.50-0.87]), AC (OR [95% CI]: 0.36 [0.20-0.66]), and trended lower than SE (OR [95% CI]: 0.71 [0.40-1.26]). Notably, ST had higher major bleeding risks than CDT (OR [95% CI]: 1.51 [1.19-1.91]) and AC (OR [95% CI]: 2.21 [1.53-3.19]). By rankogram analysis, CDT presented the highest p-score in in-hospital mortality, long-term mortality, and recurrent PE. CONCLUSION: In this network meta-analysis of observational studies and RCTs involving patients with intermediate to high-risk PE, CDT was associated with improved mortality outcomes compared to other therapies, without significant additional bleeding risk.
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Ishisaka et al. (2023) conducted a meta-analysis in intermediate to high-risk pulmonary embolism (n=157,454). Catheter-directed therapy (CDT) vs. Systemic thrombolysis (ST), therapeutic anticoagulation (AC), and surgical embolectomy (SE) was evaluated on in-hospital mortality (OR 0.41, 95% CI 0.31-0.55). Catheter-directed therapy was associated with lower in-hospital mortality than systemic thrombolysis (OR 0.41; 95% CI 0.31-0.55), anticoagulation, and surgical embolectomy.
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