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. 2022 Jun 30:9:880189.
doi: 10.3389/fcvm.2022.880189. eCollection 2022.

Association Between the Use of Pre- and Post-thrombolysis Anticoagulation With All-Cause Mortality and Major Bleeding in Patients With Pulmonary Embolism

Jiang-Shan Tan  1 , Ningning Liu  2   3 , Song Hu  1 , Yan Wu  1 , Xin Gao  1 , Ting-Ting Guo  1 , Xin-Xin Yan  1 , Fu-Hua Peng  1 , Lu Hua  1
Affiliations

Association Between the Use of Pre- and Post-thrombolysis Anticoagulation With All-Cause Mortality and Major Bleeding in Patients With Pulmonary Embolism

Jiang-Shan Tan et al. Front Cardiovasc Med. .

Abstract

Objective: To explore the comparative clinical efficacy and safety outcomes of anticoagulation before (pre-) or following (post-) thrombolytic therapy in systemic thrombolytic therapy for pulmonary embolism (PE).

Methods: PubMed, the Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases were searched from inception through 1 May 2021. All randomized clinical trials comparing systemic thrombolytic therapy vs. anticoagulation alone in patients with PE and those that were written in English were eligible. The primary efficacy and safety outcomes were all-cause mortality and major bleeding, respectively. Odds ratios (OR) estimates and associated 95% confidence intervals (CIs) were calculated. A Bayesian network analysis was performed using R studio software, and then the efficacy and safety rankings were derived.

Results: This network meta-analysis enrolled 15 trials randomizing 2,076 patients. According to the plot rankings, the anticoagulant therapy was the best in terms of major bleeding, and the post-thrombolysis anticoagulation was the best in terms of all-cause mortality. Taking major bleeding and all-cause mortality into consideration, the most safe-effective treatment was the post-thrombolysis anticoagulation in patients who needed thrombolytic therapy. The net clinical benefit analysis comparing associated ICH benefits vs. mortality risks of post-thrombolysis anticoagulation demonstrated a net clinical benefit of 1.74%.

Conclusion: The systemic thrombolysis followed by anticoagulation had a better advantage in all-cause mortality and major bleeding than the systemic thrombolysis before anticoagulation. The adjuvant anticoagulation treatment of systemic thrombolytic therapy should be optimized.

Keywords: all-cause mortality; anticoagulation (AC); major bleeding; pulmonary embolism; thrombolysis/thrombolytic agents.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Search strategy and study selection.
FIGURE 2
FIGURE 2
Network of the comparisons for the Bayesian network analysis. The size of the nodes is proportional to the number of patients (in parentheses) randomized to receive the treatment. The width of the lines is proportional to the number of trials (beside the line) comparing the connected treatments. However, we excluded the trials in which both events in the experimental and control groups were 0 in specific analysis. k—number of trials per comparison; n—number of patients per comparison.
FIGURE 3
FIGURE 3
Forest plots for relative effect as compared with anticoagulation.
FIGURE 4
FIGURE 4
Ranking plots. Strategy ranking plots for primary and secondary outcomes are stratified by treatment. (A) Is the ranking plot for major bleeding; (B) is the plot for recurrence; (C) is the plot for all-cause mortality and (D) is the plot for composite outcome. Each line represents 1 strategy and shows the probability of its ranking from best to worst. The peak of the line represents the rank that the strategy is most likely to be for each given outcome. For example, for all-cause mortality, post- thrombolytic anticoagulation is most likely to rank best; pre- thrombolytic anticoagulation, second best; and anticoagulation, worst.
FIGURE 5
FIGURE 5
Ranking plot in consideration of efficiency and safety.
See this image and copyright information in PMC

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References

    1. Chatterjee S, Chakraborty A, Weinbe0rg I, Kadakia M, Wilensky RL, Sardar P, et al. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA. (2014) 311:2414–21. - PubMed
    1. Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol. (1997) 30:1165–71. 10.1016/s0735-1097(97)00319-7 - DOI - PubMed
    1. Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser K, Rauber K, et al. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation. (1997) 96:882–8. 10.1161/01.cir.96.3.882 - DOI - PubMed
    1. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. (2016) 149:315–52. - PubMed
    1. Stein PD, Hull RD, Raskob G. Risks for major bleeding from thrombolytic therapy in patients with acute pulmonary embolism. Consideration of noninvasive management. Ann Intern Med. (1994) 121:313–7. 10.7326/0003-4819-121-5-199409010-00001 - DOI - PubMed

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