Why the study?
Optimal reperfusion for intermediate-risk pulmonary embolism remains uncertain, and previous meta-analyses combined observational and randomized data rather than evaluating randomized controlled trials alone with granular treatment classification.
Do catheter-based or systemic reperfusion strategies reduce 30-day mortality compared with anticoagulation in patients with intermediate-risk pulmonary embolism?
Meta-Analysis (n=2,793)
Do catheter-based or systemic reperfusion strategies reduce 30-day mortality compared with anticoagulation in patients with intermediate-risk pulmonary embolism?
Answers are grounded in this paper and cite their sources.
In intermediate-risk pulmonary embolism, catheter-based therapies rank favorably for efficacy and intracranial hemorrhage safety compared with systemic thrombolysis, though certainty remains low due to sparse mortality events.
Introduction: Optimal reperfusion for intermediate-risk pulmonary embolism (PE) remains uncertain. Previous meta-analyses combined observational and randomized data. We conducted a Bayesian Network Meta-analysis including only Randomized Controlled Trials (RCTs), incorporating recent trials (PEERLESS, STORM-PE, STRATIFY) with granular treatment classification. Methods: We searched MEDLINE, Embase, and Scopus through January 2026 for RCTs in intermediate-risk PE. Seven treatment nodes were defined: Anticoagulation (AC), Full-dose systemic thrombolysis, Reduced-dose thrombolysis, Ultrasound-assisted CDT (USAT), Standard CDT, Large-bore mechanical thrombectomy (LBMT), and Catheter embolectomy. Primary outcome: 30-day mortality. Secondary: RV/LV ratio change, decompensation, intracranial hemorrhage (ICH). Results: Fifteen RCTs (2,793 participants, 59 deaths) were included. Full-dose systemic thrombolysis showed non-significant mortality reduction versus AC (OR 0.32, 95%CrI 0.03-1.45). LBMT and CDT had lowest point estimates but wide CrIs due to rare events. USAT was the only treatment with significant RV/LV improvement (MD -0.31, 95%CrI -0.57 to -0.06). Full-dose thrombolysis increased ICH (OR 21.2, 95%CrI 2.6-645). SUCRA rankings favored catheter therapies for mortality (LBMT 14.7%, CDT 20.9%) and ICH safety (CDT 12.0%) (Table 1). Conclusions: Catheter-based therapies may offer favorable efficacy-safety profiles versus Systemic thrombolysis, but evidence certainty remains low due to sparse events. erj;68/suppl_70/PA937/F1 F1 F1
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Biswas et al. (2026) conducted a meta-analysis in Intermediate-risk pulmonary embolism (PE) (n=2,793). Reperfusion strategies (Full-dose systemic thrombolysis, Reduced-dose thrombolysis, Ultrasound-assisted CDT, Standard CDT, Large-bore mechanical thrombectomy, Catheter embolectomy) vs. Anticoagulation (AC) was evaluated on 30-day mortality (OR 0.32, 95% CI 0.03-1.45).
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