title: Thrombolysis in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis.
abstract: BACKGROUND
  The role of thrombolysis in hemodynamically stable patients with acute pulmonary embolism (PE) remains controversial. We performed a meta-analysis of randomized trials to assess the effect of thrombolysis in these patients.
  
  
  METHODS
  We searched MEDLINE and EMBASE for randomized studies comparing thrombolysis and heparin for the initial treatment of hemodynamically stable PE patients. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated. NNH to cause a major bleeding (MB) or an intracranial hemorrhage (ICH) and NNT to avoid one death were also calculated.
  
  
  RESULTS
  Eleven studies (1833 patients) were included seven with rt-PA, three with tenecteplase and one with urokinase. Patients randomized to thrombolysis had a significant increased risk for MB (5.9% vs 1.9%; OR 2.83, 95% CI 1.68-4.76, I2 18.7%) and an increased risk for ICH (1.74% versus 0.6%; OR 2.36, 95% CI 0.98-5.71, I2 0%) and for fatal bleeding (1.3% versus 0.54%; OR 1.84, 95% CI 0.73-4.61, I2 0%). A not-significant reduction for all-cause death (1.74% vs 2.51%; OR 0.68, 95% CI 0.37-1.26, I2 0%) and a significant reduction for recurrent PE (1.1% vs 2.5%; OR 0.44, 95% CI 0.21-0.92, I2 0%) in favor of thrombolysis compared with heparin was found. NNH to cause a MB or an ICH were 27 and 91 patients, respectively. NNT to avoid one death was 125 patients.
  
  
  CONCLUSIONS
  Due to increased risk for MB and ICH with no evidence of reduction in mortality, thrombolysis should not be used for most normotensive PE patients.
authors.affiliation: Internal Medicine, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat Barcelona Spain. ariera@bellvitgehospital.cat
authors.forename: Antoni
authors.initials: A
authors.lastname: Riera-Mestre
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
authors.forename: Michela
authors.initials: M
authors.lastname: Giustozzi
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D015984:Causality; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000401:mortality; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality*; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000401:mortality*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006493:Heparin