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Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis.

Marti C, John G, Konstantinides S, Combescure C, Sanchez O, Lankeit M, Meyer G, Perrier A - Eur. Heart J. (2014)

Bottom Line: Thrombolytic therapy was associated with a significant reduction in the combined endpoint of death or treatment escalation (OR: 0.34, 95% CI: 0.22-0.53), PE-related mortality (OR: 0.29; 95% CI: 0.14-0.60) and PE recurrence (OR: 0.50; 95% CI: 0.27-0.94).The decrease in overall mortality is, however, not significant in haemodynamically stable patients with acute PE.Thrombolytic therapy is associated with an increase of major and fatal or intracranial haemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland christophe.marti@hcuge.ch.

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Early mortality by pulmonary embolism severity, Forest plot.
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EHU218F2: Early mortality by pulmonary embolism severity, Forest plot.

Mentions: All 15 studies including 2057 patients reported early (≤30 days) all-cause mortality. The reported mortality was 2.3% (24/1033) in the thrombolysis group and 3.9% (40/1024) in the control group. Thrombolytic therapy was associated with a significant reduction of early mortality (pooled OR: 0.59; 95% CI: 0.36–0.96, P = 0.03; Figure 2). No heterogeneity was observed among studies (I2 = 0%). After exclusion of studies including high-risk PE, treatment effect was similar, but statistical significance was lost (OR: 0.64; 95% CI: 0.35–1.17). The pooled ORs were similar in studies including high-risk PE (OR: 0.48; 95% CI: 0.2–1.15) and studies including only intermediate-risk PE (0.42; 95% CI: 0.17–1.03), whereas the pooled OR was close to one in studies including both low- and intermediate-risk PE (0.96; 95% CI: 0.41–2.24) (Table 2 and Figure 2). Subgroup analysis based on the thrombolytic regimen did not show any significant differences between alteplase (OR: 0.64; 95% CI: 0.29–1.41), tenecteplase (OR: 0.65; 95% CI: 0.26–1.64) or older thrombolytics (OR: 0.48; 95% CI: 0.20–1.15) (P = 0.86).Table 2


Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis.

Marti C, John G, Konstantinides S, Combescure C, Sanchez O, Lankeit M, Meyer G, Perrier A - Eur. Heart J. (2014)

Early mortality by pulmonary embolism severity, Forest plot.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352209&req=5

EHU218F2: Early mortality by pulmonary embolism severity, Forest plot.
Mentions: All 15 studies including 2057 patients reported early (≤30 days) all-cause mortality. The reported mortality was 2.3% (24/1033) in the thrombolysis group and 3.9% (40/1024) in the control group. Thrombolytic therapy was associated with a significant reduction of early mortality (pooled OR: 0.59; 95% CI: 0.36–0.96, P = 0.03; Figure 2). No heterogeneity was observed among studies (I2 = 0%). After exclusion of studies including high-risk PE, treatment effect was similar, but statistical significance was lost (OR: 0.64; 95% CI: 0.35–1.17). The pooled ORs were similar in studies including high-risk PE (OR: 0.48; 95% CI: 0.2–1.15) and studies including only intermediate-risk PE (0.42; 95% CI: 0.17–1.03), whereas the pooled OR was close to one in studies including both low- and intermediate-risk PE (0.96; 95% CI: 0.41–2.24) (Table 2 and Figure 2). Subgroup analysis based on the thrombolytic regimen did not show any significant differences between alteplase (OR: 0.64; 95% CI: 0.29–1.41), tenecteplase (OR: 0.65; 95% CI: 0.26–1.64) or older thrombolytics (OR: 0.48; 95% CI: 0.20–1.15) (P = 0.86).Table 2

Bottom Line: Thrombolytic therapy was associated with a significant reduction in the combined endpoint of death or treatment escalation (OR: 0.34, 95% CI: 0.22-0.53), PE-related mortality (OR: 0.29; 95% CI: 0.14-0.60) and PE recurrence (OR: 0.50; 95% CI: 0.27-0.94).The decrease in overall mortality is, however, not significant in haemodynamically stable patients with acute PE.Thrombolytic therapy is associated with an increase of major and fatal or intracranial haemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland christophe.marti@hcuge.ch.

Show MeSH
Related in: MedlinePlus