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Catheter-directed Thrombolysis versus Systemic Anticoagulation for Submassive Pulmonary Embolism: A Meta-Analysis
Juan Arturo Siordia1, Amanpreet Kaur2
1Department of Internal Medicine, Banner-University Medical Center - South Campus, 2800 E Ajo Way, Tucson, AZ 85713, United States.
Insights
Catheter-directed thrombolysis (CDT) shows lower 30-day and one-year mortality for submassive pulmonary embolism compared to systemic anticoagulation (SA). Major bleeding rates were similar between treatments.
Area of Science:
- Cardiology
- Interventional Radiology
- Pulmonary Medicine
Background:
- Optimal therapy for submassive pulmonary embolism (PE) is debated.
- Systemic anticoagulation (SA) is a common treatment.
- Catheter-directed thrombolysis (CDT) is an alternative therapy.
Purpose of the Study:
- To compare the efficacy and safety of CDT versus SA for submassive PE.
- To analyze mortality and major bleeding events associated with each treatment.
Main Methods:
- A meta-analysis of six studies comparing CDT and SA for submassive PE.
- Electronic literature search conducted via PubMed and Google Scholar.
- Analysis of 30-day, 90-day, and one-year mortality, and major bleeding events.
Main Results:
- CDT demonstrated significantly lower 30-day (OR 0.27) and one-year (OR 0.50) mortality.
- Ninety-day mortality rates were comparable between CDT and SA (OR 0.57).
- Overall mortality at >30 days was reduced with CDT (OR 0.51), with similar major bleeding rates (OR 1.63).
Conclusions:
- CDT is associated with reduced 30-day and one-year mortality for submassive PE.
- CDT offers equivalent major bleeding risk compared to SA.
- CDT may be a favorable treatment option for select submassive PE patients.
Background:
The optimal therapy for submassive pulmonary embolism remains in question. The following meta-analysis compiles the current evidence comparing Catheter-Directed Thrombolysis (CDT) versus Systemic Anticoagulation (SA).
Methods:
An electronic search through PubMed and Google scholar revealed studies comparing CDT versus SA in terms of mortality and major bleeding events. Thirty-day, 90-day, and one-year mortality results were analyzed.
Results:
Six studies were included in the meta-analysis. Thirty-day and one-year mortality were less with CDT compared to SA (OR 0.27 [CI 0.11-0.67]; and OR 0.50 [CI 0.28-0.89]). Ninety-day mortality was similar between the two methods (OR 0.57 [CI 0.17-1.92]). Compilation of all studies reporting at least greater than 30-day mortality revealed less mortality with CDT (OR 0.51 [0.30-0.86]). Major bleeding was similar between the two treatments (OR 1.63 [CI 0.63-4.20]).
Conclusion:
CDT has less 30-day and 1-year mortality with equivalent rates of major bleeding compared to SA for treatment of submassive pulmonary embolism.
