Pulmonary vascular disease & thromboembolismMeta-analysis
Efficacy and Safety of Anticoagulation, Catheter-Directed Thrombolysis, or Systemic Thrombolysis in Acute Pulmonary Embolism
- Systematic review and meta-analysis of randomised and observational studies
Authors' conclusion
In patients with acute PE, when compared with AC alone, CDT was associated with a lower mortality but higher risk of bleeding. Moreover, CDT had an enhanced safety profile when compared with ST.
Study context
- Population
- Patients with acute PE
- Participants
- 81,705 patients · 45 studies
- Comparison
- Anticoagulation (AC) alone vs catheter-directed thrombolysis (CDT) vs systemic thrombolysis (ST)
- Outcome
- All-cause mortality
Pooled result
As reported in the abstract
Odds ratio (95% CI)
CDT vs AC
0.55(0.39–0.80)
ST vs CDT
2.05(1.46–2.89)
Further pooled results
Intermediate-risk PE trials (subgroup)
- Findings similar when restricted to trials of intermediate-risk PE
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Major bleeding — CDT vs AC | 1.84 (1.10–3.08) | |
| Major bleeding — ST vs AC | 2.16 (1.38–3.38) | |
| Intracranial hemorrhage — CDT vs AC · numerically higher | 1.51 (0.75–3.04) | |
| Intracranial hemorrhage — ST vs AC | 2.26 (1.14–4.48) | |
| Intracranial hemorrhage — ST vs CDT | 1.50 (1.13–1.99) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Efficacy and Safety of Anticoagulation, Catheter-Directed Thrombolysis, or Systemic Thrombolysis in Acute Pulmonary Embolism. JACC Cardiovasc Interv. Published 18 October 2023. doi:10.1016/j.jcin.2023.07.042
Summarised from the published abstract; every number is checked against it