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
Meta-Analysis
. 2015 Mar 7;36(10):605-14.
doi: 10.1093/eurheartj/ehu218. Epub 2014 Jun 10.

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

Christophe Marti  1 , Gregor John  2 , Stavros Konstantinides  3 , Christophe Combescure  4 , Olivier Sanchez  5 , Mareike Lankeit  3 , Guy Meyer  5 , Arnaud Perrier  2
Affiliations
Meta-Analysis

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

Christophe Marti et al. Eur Heart J. .

Abstract

Aim: Thrombolytic therapy induces faster clot dissolution than anticoagulation in patients with acute pulmonary embolism (PE) but is associated with an increased risk of haemorrhage. We reviewed the risks and benefits of thrombolytic therapy in the management of patients with acute PE.

Methods and results: We systematically reviewed randomized controlled studies comparing systemic thrombolytic therapy plus anticoagulation with anticoagulation alone in patients with acute PE. Fifteen trials involving 2057 patients were included in our meta-analysis. Compared with heparin, thrombolytic therapy was associated with a significant reduction of overall mortality (OR; 0.59, 95% CI: 0.36-0.96). This reduction was not statistically significant after exclusion of studies including high-risk PE (OR; 0.64, 95% CI: 0.35-1.17). 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). Major haemorrhage (OR; 2.91, 95% CI: 1.95-4.36) and fatal or intracranial bleeding (OR: 3.18, 95% CI: 1.25-8.11) were significantly more frequent among patients receiving thrombolysis.

Conclusions: Thrombolytic therapy reduces total mortality, PE recurrence, and PE-related mortality in patients with acute PE. 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.

Keywords: Pulmonary embolism; Systematic review; Thrombolytic therapy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Early mortality by pulmonary embolism severity, Forest plot.
Figure 3
Figure 3
Major bleeding by drug, Forest plot.
Figure 4
Figure 4
Early mortality, Funnel plot of included studies.
See this image and copyright information in PMC

References

    1. Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med. 2011;171:831–837. - PMC - PubMed
    1. Kroger K, Moerchel C, Moysidis T, Santosa F. Incidence rate of pulmonary embolism in Germany: data from the federal statistical office. J Thromb Thrombolysis. 2010;29:349–353. - PubMed
    1. Laporte S, Mismetti P, Decousus H, Uresandi F, Otero R, Lobo JL, Monreal M. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation. 2008;117:1711–1716. - PubMed
    1. Aujesky D, Hughes R, Jimenez D. Short-term prognosis of pulmonary embolism. J Thromb Haemost. 2009;7(Suppl. 1):318–321. - PubMed
    1. Stein PD, Kayali F, Olson RE. Estimated case fatality rate of pulmonary embolism, 1979 to 1998. Am J Cardiol. 2004;93:1197–1199. - PubMed

Publication types

MeSH terms