Thrombolytic therapy for pulmonary embolism.

Area of Science:

• Cardiology
• Pulmonary Medicine
• Pharmacology

Background:

• Thrombolytic therapy is typically reserved for severe pulmonary embolism (PE).
• While evidence suggests thrombolytics can dissolve clots faster than heparin and reduce PE-related mortality, concerns exist regarding increased hemorrhage risk.
• This is the third update of a Cochrane review first published in 2006.

Purpose of the Study:

• To evaluate the efficacy and safety of thrombolytic therapy for acute pulmonary embolism (PE).

Main Methods:

• Included 18 randomized controlled trials (RCTs) comparing thrombolytics plus heparin versus heparin alone or placebo.
• Searched multiple databases up to April 2018, including Cochrane Vascular, MEDLINE, Embase, and clinical trial registries.
• Assessed trial eligibility, quality (GRADE criteria), and extracted data; meta-analysis used odds ratios (OR) and mean differences (MD).

Main Results:

• Thrombolytics plus heparin significantly reduced the odds of death (OR 0.57) and PE recurrence (OR 0.51) compared to heparin alone, based on low-quality evidence.
• However, thrombolytic therapy significantly increased the incidence of major (OR 2.90) and minor (OR 3.09) hemorrhagic events.
• Hospital stay and quality of life were similar; limited data suggested potential benefits in hemodynamic and clinical outcomes, but heterogeneity and small sample sizes necessitate caution.

Conclusions:

• Low-quality evidence indicates thrombolytics may decrease mortality and PE recurrence but elevate bleeding risks.
• Further high-quality, blinded RCTs are essential to rigorously assess the safety and cost-effectiveness of thrombolytic therapies for PE.