Thrombolysis in hemodynamically stable patients with acute pulmonary embolism: A meta-analysis

被引:36
作者
Riera-Mestre, Antoni [1 ]
Becattini, Cecilia [2 ]
Giustozzi, Michela [2 ]
Agnelli, Giancarlo [2 ]
机构
[1] Hosp Univ Bellvitge, IDIBELL, Barcelona 08907, Spain
[2] Univ Perugia, Stroke Unit, I-06100 Perugia, Italy
关键词
Pulmonary thromboembolism; Thrombolytic therapy; Bleeding; Prognosis; Venous thromboembolism; TISSUE-PLASMINOGEN-ACTIVATOR; HEMORRHAGIC COMPLICATIONS; INTRACRANIAL HEMORRHAGE; RANDOMIZED-TRIAL; CLINICAL-TRIALS; DOSAGE REGIMEN; RT-PA; THERAPY; BOLUS; RISK;
D O I
10.1016/j.thromres.2014.10.004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: 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. Materials and 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, I-2 18.7%) and an increased risk for ICH (1.74% versus 0.6%; OR 2.36, 95% CI 0.98-5.71, I-2 0%) and for fatal bleeding (1.3% versus 0.54%; OR 1.84, 95% CI 0.73-4.61, I-2 0%). A not-significant reduction for all-cause death (1.74% vs 2.51%; OR 0.68, 95% CI 0.37-1.26, I-2 0%) and a significant reduction for recurrent PE (1.1% vs 2.5%; OR 0.44, 95% CI 0.21-0.92, I-2 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. (C) 2014 Elsevier Ltd. All rights reserved.
引用
收藏
页码:1265 / 1271
页数:7
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