Recombinant tissue plasminogen activator for hemodynamically stable patients experiencing an acute pulmonary embolism: a meta-analysis.
BACKGROUND
The role of thrombolytic therapy for the initial treatment of hemodynamically stable patients experiencing an acute pulmonary embolism remains controversial.


RESULTS
We performed a meta-analysis of randomized trials comparing between administration of recombinant tissue plasminogen activator (rt-PA) and heparin in hemodynamically stable patients experiencing an acute pulmonary embolism. Seven trials, involving 594 patients, were included in this meta-analysis. Compared with heparin, rt-PA was associated with a non-significant reduction in death (2.75% versus 3.96%; RR 0.69, 95% CI 0.31-1.52, P for heterogeneity=0.520) and recurrent pulmonary embolism (2.13% versus 3.34%; RR 0.70, 95% CI 0.28-1.73), and a non-significant increase in major bleeding (5.15% versus 4.29%; RR 1.06, 95% CI 0.520-2.150). Similar results were found based on a subgroup analysis of patients displaying echocardiographic evidence of right ventricular dysfunction (RVD). In contrast, rt-PA treatment was associated with a significant reduction in escalation of care in trials that also enrolled patients displaying RVD compared with heparin treatment (6.56% versus 19.7%; RR 0.34, 95% CI 0.20-0.65).


CONCLUSIONS
The currently available data provide no evidence for a benefit of administration of rt-PA compared with heparin for the initial treatment of hemodynamically stable patients experiencing an acute pulmonary embolism. However, rt-PA is partially beneficial specifically among patients displaying RVD.
Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Yunfeng
Y
Liu
Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Youjin
Y
Lu
School of Public Health, Anhui Medical University, Hefei, China.
Jian
J
Song
Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei, China.
Dan
D
Li
Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Hongyan
H
Liu
Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Jin
J
Yang
Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China. Electronic address: zhaohuichenxi2@126.com.
Hui
H
Zhao
D000208:Acute Disease; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011379:Prognosis; D011655:Pulmonary Embolism / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D006493:Heparin; D010959:Tissue Plasminogen Activator
embolism; hemodynamically stable; heparin; meta-analysis; thrombolysis