title: Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Thrombolytic therapy induces faster clot dissolution than anticoagulation in patients with acute pulmonary embolism (PE) but is associated with an increased risk of haemorrhage. We reviewed the risks and benefits of thrombolytic therapy in the management of patients with acute PE.
  
  
  RESULTS
  We systematically reviewed randomized controlled studies comparing systemic thrombolytic therapy plus anticoagulation with anticoagulation alone in patients with acute PE. Fifteen trials involving 2057 patients were included in our meta-analysis. Compared with heparin, thrombolytic therapy was associated with a significant reduction of overall mortality (OR; 0.59, 95% CI: 0.36-0.96). This reduction was not statistically significant after exclusion of studies including high-risk PE (OR; 0.64, 95% CI: 0.35-1.17). Thrombolytic therapy was associated with a significant reduction in the combined endpoint of death or treatment escalation (OR: 0.34, 95% CI: 0.22-0.53), PE-related mortality (OR: 0.29; 95% CI: 0.14-0.60) and PE recurrence (OR: 0.50; 95% CI: 0.27-0.94). Major haemorrhage (OR; 2.91, 95% CI: 1.95-4.36) and fatal or intracranial bleeding (OR: 3.18, 95% CI: 1.25-8.11) were significantly more frequent among patients receiving thrombolysis.
  
  
  CONCLUSIONS
  Thrombolytic therapy reduces total mortality, PE recurrence, and PE-related mortality in patients with acute PE. The decrease in overall mortality is, however, not significant in haemodynamically stable patients with acute PE. Thrombolytic therapy is associated with an increase of major and fatal or intracranial haemorrhage.
authors.affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland christophe.marti@hcuge.ch.
authors.forename: Christophe
authors.initials: C
authors.lastname: Marti
authors.affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: Gregor
authors.initials: G
authors.lastname: John
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
authors.affiliation: Department of Health and Community Medicine, University Hospitals of Geneva and Geneva Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
authors.affiliation: Hôpital Européen Georges Pompidou, AP-HP; Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S 970, Paris; GIRC Thrombose, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sanchez
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Lankeit
authors.affiliation: Hôpital Européen Georges Pompidou, AP-HP; Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S 970, Paris; GIRC Thrombose, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
authors.affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D017594:Publication Bias; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: Pulmonary embolism; Systematic review; Thrombolytic therapy