Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis.
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.
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 email@example.com.Show MeSH
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Mentions: The inspection of funnel plots revealed potential publication bias, especially for PE recurrence and death or treatment escalation (P = 0.02 for both, Egger's test). Missing studies for the funnel plots to be symmetrical (trim and fill method) would be studies with low precision and ORs in favour of controls. One missing study was detected for the outcome overall mortality (Figure 4) (study symmetrical to Jerjes-Sanchez) and three studies for the outcome PE recurrence. If these missing studies were added, the ORs for the outcomes overall mortality and PE-related mortality remained in favour of thrombolytic treatment but were not significantly different from 1 (0.69, 95% CI: 0.40–1.19 and 0.84, 95% CI: 0.44–1.60). For the other outcomes, the ORs were slightly modified and remained significantly different from 1.
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 firstname.lastname@example.org.