Thrombolytic therapy of pulmonary embolism: a meta-analysis.
OBJECTIVE
We sought to assess the efficacy and safety of thrombolytic therapy in patients with an acute pulmonary embolism (PE).


BACKGROUND
Thrombolytic therapy is approved for the treatment of acute PE; however, the safety and efficacy of this therapy remain debated.


METHODS
A meta-analysis of randomized, controlled trials comparing thrombolytic agents with intravenous heparin in patients with acute PE was performed. Trials were identified through a combined search of the MEDLINE, EMBASE, and Current Contents databases. Three outcome measures were assessed: 1) mortality, 2) recurrence of PE, and 3) major hemorrhage.


RESULTS
Nine trials including 461 patients were identified. Compared with intravenous heparin, thrombolytic therapy had no significant effect on mortality (relative risk [RR] 0.63, 95% confidence interval [CI] 0.32 to 1.23) or the recurrence of PE (RR 0.59, 95% CI 0.30 to 1.18), but was associated with an increased risk of major hemorrhage (RR 1.76, 95% CI 1.04 to 2.98). These results were homogeneous and largely unaffected by the formulation of thrombolytic agent, the clinical severity of PE, the extent of vascular obstruction determined radiologically, or the methodologic quality of the included trials.


CONCLUSIONS
Compared with intravenous heparin, thrombolytic therapy does not appear to have therapeutic benefit in unselected patients with acute PE, but it is associated with an increased risk of major hemorrhage. Given the small number of patients included in the randomized trials thus far, the negative results in terms of the efficacy outcomes should be interpreted with caution. Definitive evidence of the utility of thrombolytic therapy in this setting requires a large, randomized, controlled trial.
Thabut
Gabriel
G
Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, 100 avenue du Général Leclerc, 92110 Clichy, France. gabriel.thabut@bjn.ap-hop-paris.fr
Thabut
Dominique
D
Myers
Robert P
RP
Bernard-Chabert
Brigitte
B
Marrash-Chahla
Rolana
R
Mal
Hervé
H
Fournier
Michel
M
D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000209:etiology; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D010960:Plasminogen Activators / Q000009:adverse effects / Q000627:therapeutic use*; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality; D012008:Recurrence; D012306:Risk; D013300:Streptokinase / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D006493:Heparin; D013300:Streptokinase; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator