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February 1, 2014Patient Preference and AdherenceOpen Access

Systematic review and meta-analysis for thrombolysis treatment in patients with acute submassive pulmonary embolism

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Key result

Thrombolysis did not significantly reduce mortality (2.7% vs 4.3%; RR 0.64; P=0.27) or recurrent PE compared with heparin alone in patients with submassive pulmonary embolism.

Why the study?

Does thrombolytic treatment reduce mortality or recurrent PE in adults with acute submassive pulmonary embolism compared to intravenous heparin alone?

Population

594 adults with acute submassive pulmonary embolism pooled from 7 prospective, randomized clinical trials.

Comparison

Thrombolytic treatment vs Intravenous heparin alone

Design

Meta-analysis

Authors

JCJie CaoYCYaoqian CaoHCHaiyan Chen

Discussion

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Overview

Thrombolysis should not be routine in submassive PE; confirms heparin alone suffices and challenges broader lytic adoption.

Key Points

  • To evaluate the efficacy and safety of thrombolytic therapy compared with heparin alone in normotensive patients with acute submassive pulmonary embolism and right ventricular dysfunction.
  • Systematic search of MEDLINE, Embase, Science Citation Index, and Cochrane Library for prospective randomized clinical trials.
  • Evaluated trials comparing thrombolytic therapy against intravenous heparin alone across 7 studies involving 594 patients.
  • Thrombolysis did not significantly reduce mortality (2.7% vs 4.3%; RR=0.64, 95% CI [0.29-1.40]; P=0.27) or recurrent pulmonary embolism (2% vs 5%; RR=0.44, 95% CI [0.19-1.05]; P=0.06) compared with heparin.
  • Major hemorrhage risk was not significantly increased with thrombolysis compared with heparin (4.5% vs 3.3%; RR=1.16, 95% CI [0.51-2.60]; P=0.73), but minor hemorrhage occurred significantly more often (41% vs 9%; RR=3.91, 95% CI [1.46-10.48]; P=0.007).

Study Design

Type

Meta-Analysis (n=594)

Structured PICO

Does thrombolytic treatment reduce mortality or recurrent PE in adults with acute submassive pulmonary embolism compared to intravenous heparin alone?

P
Population
594 adults with submassive pulmonary embolism, right ventricular dysfunction, and normotension included across 7 prospective, randomized clinical trials.
I
Intervention
Thrombolytic treatment
C
Comparator
Intravenous heparin alone
O
Outcome
Mortality, recurrent PE, and bleeding risk (major and minor hemorrhage)hard clinical

Main Result

Relative Risk: 0.64 (95% CI 0.29–1.4)

Absolute Event Rate: 2.7% vs 4.3%

p-value: p=0.27

In patients with acute submassive pulmonary embolism, thrombolysis does not significantly reduce mortality or recurrent PE compared to heparin alone, but increases the risk of minor bleeding.

Limitations

  • The number of patients enrolled in the trials is limited
  • limited number of patients enrolled in the trials

Cite This Study

Cao et al. (2014) conducted a meta-analysis in submassive pulmonary embolism (PE) (n=594). Thrombolysis vs. Intravenous heparin was evaluated on Mortality (RR 0.64, 95% CI 0.29-1.40, p=0.27). Thrombolysis did not significantly reduce mortality (2.7% vs 4.3%; RR 0.64; P=0.27) or recurrent PE compared with heparin alone in patients with submassive pulmonary embolism.

synapsesocial.com/papers/6a8fa2dc418deb56e52bbd7fhttps://doi.org/10.2147/ppa.s56280
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Also Consider

Synapse has enriched 2 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Thrombolysis Compared With Heparin for the Initial Treatment of Pulmonary Embolism2004 · 617 citations
  2. 2Intravenous and intrapulmonary recombinant tissue-type plasminogen activator in the treatment of acute massive pulmonary embolism.1988 · 407 citations