Thrombolytic therapy for pulmonary embolism

Abstract

We cannot conclude whether thrombolytic therapy is better than heparin for pulmonary embolism based on the limited evidence found. More double-blind RCTs, with subgroup analysis of patients presenting with haemodynamically stable acute pulmonary embolism compared to those patients with a haemodynamic unstable condition, are required.

Thrombolysis for Pulmonary Embolism and Venous Thrombosis: Is It Worthwhile?

“…23 Compared with heparin, thrombolytic therapy was not associated with a reduction in death. Similar results were found in the Cochrane collaboration review 25 : death rates and recurrence rates of PE were similar for thrombolytics and heparin, OR 0.89 (95% CI, 0.45 to 1.78) and OR 0.63 (95% CI, 0.33 to 1.20) for death rate and PE recurrence rate, respectively (no distinction massive and nonmassive PE patients).…”

Thrombolysis for Pulmonary Embolism and Venous Thrombosis: Is It Worthwhile?

“…23 Compared with heparin, thrombolytic therapy was not associated with a reduction in death. Similar results were found in the Cochrane collaboration review 25 : death rates and recurrence rates of PE were similar for thrombolytics and heparin, OR 0.89 (95% CI, 0.45 to 1.78) and OR 0.63 (95% CI, 0.33 to 1.20) for death rate and PE recurrence rate, respectively (no distinction massive and nonmassive PE patients).…”

Thrombolysis for Pulmonary Embolism and Risk of All-Cause Mortality, Major Bleeding, and Intracranial Hemorrhage

“…13 A 0-cell or continuity correction was not used based on recommendations regarding calculation of a Peto OR for studies with 0 events in only 1 group. 13 inclusion of the latest trials [8][9][10][11]29,30 is reflective of contemporary clinical practice patterns, and our results contradict the prior Cochrane review, 32 as well as multiple guidelines that have not included the most recent data. 33,34 Prior guidelines indicated that mortality advantages of thrombolytics in patients with intermediate-risk PE may be difficult to demonstrate in randomized trials given the relatively low event rates seen in this population and the difficulty and expense of organizing such trials.…”

Systemic thrombolysis for acute massive pulmonary embolism in the immediate postoperative period after bariatric surgery

“…In a recent meta-analysis, the incidence of intracranial hemorrhage was not increased in the thrombolysis group when compared with heparin alone [13]. Moreover, recent data from a Cochrane collaboration review confirmed the nonsignificant increase in the risk of major and nonmajor bleeding after thrombolytic therapy for PE [17].…”

Thrombolysis for Pulmonary Embolism and Venous Thrombosis: Is It Worthwhile?

“…23 Compared with heparin, thrombolytic therapy was not associated with a reduction in death. Similar results were found in the Cochrane collaboration review 25 : death rates and recurrence rates of PE were similar for thrombolytics and heparin, OR 0.89 (95% CI, 0.45 to 1.78) and OR 0.63 (95% CI, 0.33 to 1.20) for death rate and PE recurrence rate, respectively (no distinction massive and nonmassive PE patients).…”

Thrombolysis for Pulmonary Embolism and Risk of All-Cause Mortality, Major Bleeding, and Intracranial Hemorrhage

“…13 A 0-cell or continuity correction was not used based on recommendations regarding calculation of a Peto OR for studies with 0 events in only 1 group. 13 inclusion of the latest trials [8][9][10][11]29,30 is reflective of contemporary clinical practice patterns, and our results contradict the prior Cochrane review, 32 as well as multiple guidelines that have not included the most recent data. 33,34 Prior guidelines indicated that mortality advantages of thrombolytics in patients with intermediate-risk PE may be difficult to demonstrate in randomized trials given the relatively low event rates seen in this population and the difficulty and expense of organizing such trials.…”

Systemic thrombolysis for acute massive pulmonary embolism in the immediate postoperative period after bariatric surgery

“…In a recent meta-analysis, the incidence of intracranial hemorrhage was not increased in the thrombolysis group when compared with heparin alone [13]. Moreover, recent data from a Cochrane collaboration review confirmed the nonsignificant increase in the risk of major and nonmajor bleeding after thrombolytic therapy for PE [17].…”

Thrombolysis for Pulmonary Embolism and Venous Thrombosis: Is It Worthwhile?

“…23 Compared with heparin, thrombolytic therapy was not associated with a reduction in death. Similar results were found in the Cochrane collaboration review 25 : death rates and recurrence rates of PE were similar for thrombolytics and heparin, OR 0.89 (95% CI, 0.45 to 1.78) and OR 0.63 (95% CI, 0.33 to 1.20) for death rate and PE recurrence rate, respectively (no distinction massive and nonmassive PE patients).…”

Thrombolysis for Pulmonary Embolism and Risk of All-Cause Mortality, Major Bleeding, and Intracranial Hemorrhage

“…13 A 0-cell or continuity correction was not used based on recommendations regarding calculation of a Peto OR for studies with 0 events in only 1 group. 13 inclusion of the latest trials [8][9][10][11]29,30 is reflective of contemporary clinical practice patterns, and our results contradict the prior Cochrane review, 32 as well as multiple guidelines that have not included the most recent data. 33,34 Prior guidelines indicated that mortality advantages of thrombolytics in patients with intermediate-risk PE may be difficult to demonstrate in randomized trials given the relatively low event rates seen in this population and the difficulty and expense of organizing such trials.…”

Systemic thrombolysis for acute massive pulmonary embolism in the immediate postoperative period after bariatric surgery

“…In a recent meta-analysis, the incidence of intracranial hemorrhage was not increased in the thrombolysis group when compared with heparin alone [13]. Moreover, recent data from a Cochrane collaboration review confirmed the nonsignificant increase in the risk of major and nonmajor bleeding after thrombolytic therapy for PE [17].…”