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.

Are cardiovascular trial results systematically different between North America and Europe? A study based on intra-meta-analysis comparisons

“…For meta-analyses with non-fatal endpoints, there are 23 such overlapping metaanalyses [17,19,20,[26][27][28][30][31][32][33]35,[38][39][40][41][43][44][45][46][47][48][49][50]. Therefore, there are 18 meta-analyses with fatal endpoints [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] and 21 meta-analyses with non-fatal endpoints [15,22,25,42,[52][53][54][55]57,59,…”

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].…”

“…Hemodynamically stable patients with acute PE and right ventricular dysfunction might also benefit from thrombolysis [16]. However, the use of thrombolytic agents in this setting remains controversial [13,17].…”

Thrombolysis in submassive pulmonary embolism, prudent or puerile?

“…It has been shown that at 24 h, thrombolytic therapy improves cardiopulmonary hemodynamics, that is, echocardiographic assessment of RV wall movement, mean pulmonary artery pressure, arteriovenous oxygen and pulmonary perfusion improvement 11. A meta-analysis by Wan et al 12 in 2004, found that thrombolytic therapy compared with heparin was associated with a significant reduction in recurrent PE or death in trials that enrolled patients with major (haemodynamically unstable) PE (9.4% vs 19%; OR 0.45, 95% CI 0.22 to 0.92; number needed to treat=10) but not in trials that excluded these patients.…”