Title:Comparison of Efficacy and Safety between Thrombolysis Plus Anticoagulation
vs. Anticoagulation Alone for the Treatment of Acute Submassive
Pulmonary Embolism: A Systematic Review and Meta-analysis
Volume: 20
Issue: 6
Author(s): Qingyun Pan, Han Gao, Yingju Wang and Quanfang Chen*
Affiliation:
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
Keywords:
Acute submassive pulmonary embolish, thrombolysis, anticoagulant, therapy, ERS, efficacy, safety.
Abstract:
Objective: The objective of this study is to compare the efficacy and safety of thrombolysis
plus anticoagulant therapy vs. anticoagulant therapy alone in acute submassive pulmonary embolism
(PE).
Materials and Methods: The PubMed, Embase, and Cochrane Library databases were searched for
randomized clinical trials comparing thrombolytic therapy and anticoagulation vs. anticoagulation alone
in acute submassive PE patients from 1 Jan 1980 to 20 Jan 2021, with no drug or dose restrictions. Data
on upgraded treatment of clinical deterioration, all-cause mortality, PE recurrence and bleeding events
were extracted and analyzed using Revman 5.3 software.
Results: A total of 10 randomized controlled trials involving 1871 patients were included in the study
after screening. In terms of efficacy, thrombolysis combined with anticoagulant therapy reduced the
need for upgrading treatment (3.6 vs. 10.9%, risk ratio (RR) 0.36, 95% confidence interval (CI) 0.24-
0.54, p<0.00001) and PE recurrence (0.8 vs. 2.9%, RR 0.33, 95% CI 0.16-0.69, p=0.003) in patients
with acute submassive PE. Compared with anticoagulant therapy alone, the concomitant use of thrombolysis
was associated with lower all-cause mortality (1.3 vs. 3.0%, RR 0.47, 95% CI 0.26-0.87,
p=0.02), but it increased minor bleeding rate (31.4 vs. 8.4%, RR 3.71, 95% CI 2.82-4.88, p<0.0001) and
major bleeding rate (8.8 vs. 2.6%, RR 3.35, 95%CI 2.03-5.54, p<0.0001).
Conclusion: The use of thrombolysis plus anticoagulant therapy in acute submassive PE was negatively
associated with patients requiring escalation of treatment, PE recurrence, and all-cause mortality, but it
was positively associated with bleeding.
