title: Initial thrombolysis treatment compared with anticoagulation for acute intermediate-risk pulmonary embolism: a meta-analysis.
abstract: BACKGROUND
  The use of thrombolysis in patients with acute, intermediate-risk pulmonary embolism (PE) remains controversial. This meta-analysis compared the efficacy and safety of thrombolysis and anticoagulation treatments for intermediate-risk PE patients.
  
  
  METHODS
  Two investigators independently reviewed the literature and collected data from randomized controlled trials (RCTs) of thrombolysis for intermediate-risk PE in the PubMed, MEDLINE, EMBASE, the Cochrane Library, and Chinese Biomedical Literature Databases (CBM).
  
  
  RESULTS
  A total of 1,631 intermediate-risk PE patients from seven studies were included. Significant differences were not found regarding the 30-day, all-cause mortality rates between the thrombolytic and anticoagulant groups [odds ratio (OR), 0.60; 95% confident interval (CI), 0.34-1.06; P=0.08]. The rate of clinical deterioration in the thrombolytic group was lower than that in the anticoagulant group (OR, 0.27; 95% CI, 0.18-0.41; P<0.01). Recurrent PE in the thrombolytic group was also significantly lower than that in the anticoagulant group (OR, 0.34; 95% CI, 0.15-0.77; P=0.01). Comparing the thrombolytic and anticoagulation groups, the incidence of minor bleeding was significantly higher in the thrombolytic group (OR, 5.33; 95% CI, 2.85-9.97; P<0.00001), but there were no difference in the incidences of major bleeding events (OR, 2.07; 95% CI, 0.60-7.16; P=0.25).
  
  
  CONCLUSIONS
  Thrombolytic treatment for intermediate-risk PE patients, if not contraindicated, could reduce clinical deterioration and recurrence of PE, and trends towards a decrease in all-cause, 30-day mortality. Despite thrombolytic treatment having an increased total bleeding risk, there was no difference in the incidence of major bleeding events, compared with patients receiving anticoagulation treatment.
authors.affiliation: 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Qixia
authors.initials: Q
authors.lastname: Xu
authors.affiliation: 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Huang
authors.affiliation: 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Zhenguo
authors.initials: Z
authors.lastname: Zhai
authors.affiliation: 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Yuanhua
authors.initials: Y
authors.lastname: Yang
authors.affiliation: 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
keywords: Thrombolytic therapy; anticoagulation treatment; efficacy; pulmonary embolism (PE); safety