Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Feb 28:8:275-82.
doi: 10.2147/PPA.S56280. eCollection 2014.

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

Yaoqian Cao  1 , Haiyan Zhao  1 , Wanpeng Gao  1 , Yan Wang  1 , Jie Cao  1
Affiliations

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

Yaoqian Cao et al. Patient Prefer Adherence. .

Abstract

Purpose: The aim of this systematic review was to evaluate the efficacy and safety of thrombolytic treatment in patients with submassive pulmonary embolism (PE).

Methods: An electronic search was carried out based on the databases from MEDLINE, Embase, Science Citation Index (SCI), and the Cochrane Library. We included prospective, randomized, and clinical trials in thrombolysis with heparin alone in adults who had evidence of right ventricular dysfunction and normotension. The main endpoints consist of mortality, recurrent PE, and bleeding risk. The relative risk (RR) and the relevant 95% confidence intervals were determined by the dichotomous variable.

Results: Only seven studies involving 594 patients met the inclusion criteria for further review. The cumulative effect of thrombolysis, compared with intravenous heparin, demonstrated no statistically significant difference in mortality (2.7% versus 4.3%; RR=0.64 [0.29-1.40]; P=0.27) or recurrent PE (2% versus 5%; RR=0.44 [0.19-1.05]; P=0.06). Thrombolytic therapy did not increase major hemorrhage compared with intravenous heparin (4.5% versus 3.3%; RR=1.16 [0.51-2.60]; P=0.73), but it was associated with an increased minor hemorrhage (41% versus 9%; RR=3.91 [1.46-10.48]; P=0.007).

Conclusion: Compared with heparin alone, neither mortality nor recurrent PE is reduced by thrombolysis in patients with submassive PE, and it does not reveal an increasing risk of major bleeding. In addition, thrombolysis also produces the increased risk of minor bleeding; however, no sufficient evidence verifies the thrombolytic benefit in this review, because the number of patients enrolled in the trials is limited. Therefore, a large, double-blind clinical trial is required to prove the outcomes of this meta-analysis.

Keywords: heparin; pulmonary embolism; submassive pulmonary embolism; thrombolysis treatment; warfarin.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart of literature screening. Abbreviation: RCT, randomized controlled trial.
Figure 2
Figure 2
Forest plot of the mortality compared to the thrombolysis with heparin for the patients with acute submassive PE. Notes: The horizontal line represents 95% confidence interval of relative risk (RR), its central blue square is the position of RR, and the black diamond represents overall effect size. Abbreviations: M–H, Mantel–Haenszel test; CI, confidence interval; PAIMS 2, Plasminogen Activator Italian Multicenter Study 2; PIOPED, Prospective Investigation of Pulmonary Embolism Diagnosis.
Figure 3
Figure 3
Forest plot of recurrent PE compared to the thrombolysis with heparin for the patients with acute submassive PE. Notes: The horizontal line represents 95% confidence interval of relative risk (RR), its central blue square is the position of RR, and the black diamond represents overall effect size. Abbreviations: M–H, Mantel–Haenszel test; CI, confidence interval; PAIMS 2, Plasminogen Activator Italian Multicenter Study 2; PIOPED, Prospective Investigation of Pulmonary Embolism Diagnosis.
Figure 4
Figure 4
Forest plot of major bleeding compared the thrombolysis with heparin for the patients with acute submassive PE. Notes: The horizontal line represents 95% confidence interval of relative risk (RR), its central blue square is the position of RR, and the black diamond represents overall effect size. Abbreviations: M–H, Mantel–Haenszel test; CI, confidence interval; PAIMS 2, Plasminogen Activator Italian Multicenter Study 2; PIOPED, Prospective Investigation of Pulmonary Embolism Diagnosis.
Figure 5
Figure 5
Forest map of minor bleeding compared the thrombolysis with heparin for the patients of acute submassive PE. Notes: The horizontal line represents 95% confidence interval of relative risk (RR), its central blue square is the position of RR, and the black diamond represents overall effect size. Abbreviations: M–H, Mantel–Haenszel test; CI, confidence interval; PAIMS 2, Plasminogen Activator Italian Multicenter Study 2; PIOPED, Prospective Investigation of Pulmonary Embolism Diagnosis.
Figure 6
Figure 6
Funnel plot of overall effect for mortality versus study precision. Abbreviations: SE, standard error; RR, relative risk.
See this image and copyright information in PMC

References

    1. Stein PD, Matta F. Epidemiology and incidence: the scope of the problem and risk factors for development of venous thromboembolism. Crit Care Clin. 2011;27(4):907–932. - PubMed
    1. Stein PD, Matta F, Keyes DC, Willyerd GL. Impact of vena cava filters on in-hospital case fatality rate from pulmonary embolism. Am J Med. 2012;125(5):478–484. - PubMed
    1. Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med. 2012;125(5):465–470. - PubMed
    1. Stein PD, Matta F. Case fatality rate with pulmonary embolectomy for acute pulmonary embolism. Am J Med. 2012;125(5):471–477. - PubMed
    1. Kearon C, Akl EA, Comerota AJ, et al. American College of Chest Physicians Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(Suppl 2):e419S–e494S. - PMC - PubMed