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June 1, 2023老年心脏病学杂志：英文版Open Access

Outcomes of catheter-directed thrombolysis versus systemic thrombolysis in the treatment of pulmonary embolism: a meta-analysis

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Key result

Catheter-directed thrombolysis significantly reduced in-hospital mortality compared to systemic thrombolysis for pulmonary embolism (OR 0.41; 95% CI 0.30-0.56; P<0.05).

Why the study?

To evaluate the safety and efficacy of catheter-directed thrombolysis versus systemic thrombolysis in the treatment of pulmonary embolism.

Does catheter-directed thrombolysis improve clinical outcomes and safety compared to systemic thrombolysis in patients with pulmonary embolism?

Comparison

Catheter-directed thrombolysis vs systemic thrombolysis

Design

Meta-analysis of cohort studies

Authors

HMHuangtai MiaoYLYing LiangXLXiaoying Li

Discussion

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Overview

CDT was associated with lower in-hospital mortality than ST in PE; leaves open whether it should replace ST pending randomized confirmation.

Key Points

  • To evaluate the clinical efficacy and safety of catheter-directed thrombolysis compared to systemic thrombolysis in patients with pulmonary embolism.
  • Searched Cochrane Library, PubMed, and Embase through May 2020 for comparative cohort studies evaluating catheter-directed versus systemic thrombolysis in pulmonary embolism.
  • Included 8 cohort studies comprising 13,242 participants (3,962 receiving catheter-directed thrombolysis and 9,280 receiving systemic thrombolysis).
  • Evaluated study quality using the Newcastle-Ottawa Scale and analyzed mortality, bleeding, shock, and length of stay using STATA 15.1.
  • Catheter-directed thrombolysis significantly reduced in-hospital mortality (OR = 0.41, 95% CI: 0.30–0.56, P < 0.05) and the incidence of shock (OR = 0.46, 95% CI: 0.37–0.57, P < 0.05) compared to systemic thrombolysis.
  • Catheter-directed therapy was associated with higher all-cause bleeding (OR = 1.20, 95% CI: 1.04–1.39, P = 0.012), gastrointestinal bleeding (OR = 1.43, 95% CI: 1.13–1.81, P = 0.003), and longer hospital stays (SMD = 0.16, 95% CI: 0.07–0.25, P < 0.05).
  • No significant difference was detected between treatments for intracranial hemorrhage rate (OR = 0.70, 95% CI: 0.47–1.03, P = 0.070).

Study Design

Type

Meta-Analysis (n=13,242)

Structured PICO

Does catheter-directed thrombolysis improve clinical outcomes and safety compared to systemic thrombolysis in patients with pulmonary embolism?

P
Population
13,242 participants from 8 cohort studies comparing catheter-directed thrombolysis versus systemic thrombolysis for the treatment of pulmonary embolism.
I
Intervention
Catheter-directed thrombolysis (CDT)
C
Comparator
Systemic thrombolysis (ST)
O
Outcome
In-hospital mortalityhard clinical

Main Result

Odds Ratio: 0.41 (95% CI 0.3–0.56)

p-value: p=< 0.05

In this meta-analysis of cohort studies, catheter-directed thrombolysis for pulmonary embolism was associated with lower in-hospital mortality and shock compared to systemic thrombolysis, though effects on bleeding were mixed.

Cite This Study

Miao et al. (2023) conducted a meta-analysis in Pulmonary embolism (n=13,242). Catheter-directed thrombolysis (CDT) vs. Systemic thrombolysis (ST) was evaluated on In-hospital mortality rate (OR 0.41, 95% CI 0.30-0.56, p=< 0.05). Catheter-directed thrombolysis significantly reduced in-hospital mortality compared to systemic thrombolysis for pulmonary embolism (OR 0.41; 95% CI 0.30-0.56; P<0.05).

synapsesocial.com/papers/6a86ffb648ef9afcd2a256adhttps://doi.org/10.26599/1671-5411.2023.06.005
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Also Consider

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

  1. 1Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients2022 · 36 citations
  2. 2Outcomes of catheter-directed versus systemic thrombolysis for the treatment of pulmonary embolism: A real-world analysis of national administrative claims2020 · 36 citations
  3. 3A comparison of the efficacy and safety between anticoagulation alone and combined with catheter-directed thrombolysis for treatment of pulmonary embolism on outcome: A systematic review and meta-analysis2023 · 4 citations
  4. 4A meta-analysis of catheter-directed thrombolysis versus standard anticoagulation among patients with intermediate high risk pulmonary embolism2025
  5. 5Catheter-directed thrombolysis versus anticoagulation for intermediate-risk and high-risk pulmonary embolism: a systematic review and meta-analysis2026