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Updated: May 23, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Thrombolysis for pulmonary embolism: A network meta-analysis
Amy Ross1, Patrick Glaister2, Nichola Robinson2
1Intensive Home Support, East Lancashire Hospitals NHS Trust, Blackburn, UK.
Journal of the Intensive Care Society
|May 22, 2026
Summary
Thrombolytic agents do not improve survival for pulmonary embolism and are linked to increased bleeding risks. Tenecteplase, a specific thrombolytic, showed a higher incidence of serious bleeding events compared to placebo.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Pharmacology
Background:
- Thrombolysis is an established adjunctive therapy for pulmonary embolism (PE).
- A recent alteplase shortage prompted an evaluation of various thrombolytic agents for PE.
- Understanding the comparative efficacy and safety of thrombolytics is crucial for clinical decision-making.
Purpose of the Study:
- To systematically review and compare the efficacy and safety of different thrombolytic agents in managing pulmonary embolism.
- To assess the benefits and risks of thrombolysis versus placebo or usual care in PE patients.
Main Methods:
- A systematic review and meta-analysis of 28 studies were conducted.
- Included studies compared thrombolytic agents against placebo, usual care, or other thrombolytics.
- Both pairwise and Bayesian network meta-analyses were employed to synthesize data.
Main Results:
- Thrombolysis did not demonstrate a significant reduction in mortality compared to placebo in pairwise analysis (OR 0.69, 95% CI 0.43-1.1).
- Thrombolytic therapy was associated with a significant increase in serious bleeding events (OR 2.57, 95% CI 1.33-4.94).
- Network meta-analysis revealed no thrombolytic agent was superior to placebo for mortality; tenecteplase showed increased bleeding risk.
Conclusions:
- Current evidence suggests no thrombolytic agent offers a significant survival benefit over placebo for pulmonary embolism.
- Thrombolytic agents, especially tenecteplase, are associated with an increased risk of serious bleeding complications.
- The findings highlight the need for careful consideration of bleeding risks when using thrombolytics in PE management.
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