title: Thrombolysis for acute intermediate-risk pulmonary embolism: A meta-analysis.
abstract: BACKGROUND
  The use of thrombolytic therapy in patients with intermediate-risk pulmonary embolism is controversial. To compare with anticoagulation alone, no analysis before has determined whether thrombolytic therapy is associated with improved survival or lower incidence of adverse clinical outcomes for intermediate-risk pulmonary embolism.
  
  
  OBJECTIVE
  This meta-analysis was performed to assess mortality benefits, bleeding and recurrent pulmonary embolism risks associated with thrombolytic therapy compared with anticoagulation in patients with intermediate-risk pulmonary embolism.
  
  
  METHODS
  The Web of Science, PubMed, Embase, EBSCO, and the Cochrane Library databases were searched for randomized clinical trials comparing thrombolytic therapy with anticoagulation in intermediate-risk pulmonary embolism patients (in which the mortality data were reported) from inception to August 5, 2014. Primary outcomes were all-cause mortality and major bleeding. Secondary outcomes were recurrent pulmonary embolism and minor bleeding. The pooled relative risk (RR), Mantel-Haenszel corresponding method and fixed-effect model were used to estimate the efficacy and safety of thrombolytic therapy with 95% confidence intervals.
  
  
  RESULTS
  Eight clinical randomized controlled trials involving 1755 patients with intermediate-risk pulmonary embolism were included. Patients treated with thrombolytics presented lower mortality than patients in the anticoagulation cohort (RR, 0.52; 95% CI, 0.28-0.97; 1.39% [12/866] vs. 2.92% [26/889]). Compared with anticoagulation, thrombolytic therapy was associated with a higher risk of major (RR, 3.35; 95% CI, 2.03-5.54; 7.80% [64/820] vs. 2.28% [19/834]) and minor (RR, 3.66; 95% CI, 2.77-4.84; 32.78% [197/601] vs. 8.94% [53/593]) bleeding. Furthermore, thrombolytic therapy was associated with a lower incidence of recurrent pulmonary embolism (RR, 0.33; 95% CI, 0.15-0.73; 0.73% [6/826] vs. 2.72% [23/846]).
  
  
  CONCLUSIONS
  Compared with anticoagulation, thrombolytic therapy in patients with intermediate-risk pulmonary embolism is associated with lower all-cause mortality and recurrent pulmonary embolism risk despite increased major and minor bleeding risks.
authors.affiliation: Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China. Electronic address: hellogg09@163.com.
authors.forename: Guang-yuan
authors.initials: GY
authors.lastname: Gao
authors.affiliation: Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China. Electronic address: pyang@jlu.edu.cn.
authors.forename: Ping
authors.initials: P
authors.lastname: Yang
authors.affiliation: Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China. Electronic address: anne20081122@126.com.
authors.forename: Miao
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China. Electronic address: 35364291@qq.com.
authors.forename: Mei
authors.initials: M
authors.lastname: Ding
authors.affiliation: Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China. Electronic address: 2008.liuguohui@163.com.
authors.forename: Guo-hui
authors.initials: GH
authors.lastname: Liu
authors.affiliation: Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China. Electronic address: tongyaliang@qq.com.
authors.forename: Ya-liang
authors.initials: YL
authors.lastname: Tong
authors.affiliation: Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China. Electronic address: ycymol@163.com.
authors.forename: Chun-yan
authors.initials: CY
authors.lastname: Yang
authors.affiliation: Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China. Electronic address: mengfb@jlu.edu.cn.
authors.forename: Fan-bo
authors.initials: FB
authors.lastname: Meng
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D000925:Anticoagulants
keywords: Acute intermediate-risk pulmonary embolism; Anticoagulation; Bleeding risk; Mortality; Recurrent pulmonary embolism; Thrombolytic therapy