CLINICAL STUDY: PULMONARY EMBOLISM
Thrombolytic therapy of pulmonary embolism
A meta-analysis
Gabriel Thabut, MD*,*,
Dominique Thabut, MD ,
Robert P. Myers, MD,
Brigitte Bernard-Chabert, MD,
Rolana Marrash-Chahla, MD*,
Hervé Mal, MD* and
Michel Fournier, MD*
* Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, Clichy, France
Service d’Hépato-Gastroentérologie, Hôpital Pitié-Salpêtrière, Paris, France
Manuscript received April 7, 2002;
revised manuscript received June 25, 2002,
accepted July 15, 2002.
* Reprint requests and correspondence: Dr. Gabriel Thabut, Service de Pneumologie et Réanimation, Hôpital Beaujon, 100 avenue du Général Leclerc, 92110 Clichy, France.
gabriel.thabut{at}bjn.ap-hop-paris.fr
OBJECTIVES: We sought to assess the efficacy and safety of thrombolytic therapy in patients with an acute pulmonary embolism (PE).
BACKGROUND: Thrombolytic therapy is approved for the treatment of acute PE; however, the safety and efficacy of this therapy remain debated.
METHODS: A meta-analysis of randomized, controlled trials comparing thrombolytic agents with intravenous heparin in patients with acute PE was performed. Trials were identified through a combined search of the MEDLINE, EMBASE, and Current Contents databases. Three outcome measures were assessed: 1) mortality, 2) recurrence of PE, and 3) major hemorrhage.
RESULTS: Nine trials including 461 patients were identified. Compared with intravenous heparin, thrombolytic therapy had no significant effect on mortality (relative risk [RR] 0.63, 95% confidence interval [CI] 0.32 to 1.23) or the recurrence of PE (RR 0.59, 95% CI 0.30 to 1.18), but was associated with an increased risk of major hemorrhage (RR 1.76, 95% CI 1.04 to 2.98). These results were homogeneous and largely unaffected by the formulation of thrombolytic agent, the clinical severity of PE, the extent of vascular obstruction determined radiologically, or the methodologic quality of the included trials.
CONCLUSIONS: Compared with intravenous heparin, thrombolytic therapy does not appear to have therapeutic benefit in unselected patients with acute PE, but it is associated with an increased risk of major hemorrhage. Given the small number of patients included in the randomized trials thus far, the negative results in terms of the efficacy outcomes should be interpreted with caution. Definitive evidence of the utility of thrombolytic therapy in this setting requires a large, randomized, controlled trial.
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Abbreviations and Acronyms
| | CI | | confidence interval | | PE | | pulmonary embolism | | RR | | relative risk | | RV | | right ventricular | | rt-PA | | recombinant tissue-type plasminogen activator |
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