Catheter-Based Therapies for Intermediate-High Risk Pulmonary Embolism: A Protocol for a Systematic Review With...

Area of Science:

• Cardiology
• Interventional Pulmonology
• Medical Technology

Background:

• Intermediate-high risk pulmonary embolism (PE) presents significant challenges, often involving right ventricular dysfunction and risk of hemodynamic instability.
• Standard anticoagulation may be insufficient, while systemic thrombolysis carries a high bleeding risk.
• Catheter-based therapies offer an alternative, but their comparative effectiveness and safety require rigorous evaluation.

Purpose of the Study:

• To systematically review and meta-analyze randomized clinical trials comparing catheter-based treatments with contemporary control regimens for intermediate-high risk PE.
• To assess the benefits and harms of various catheter-based strategies, including catheter-directed thrombolysis, ultrasound-assisted thrombolysis, and embolectomy.

Main Methods:

• A systematic review and Bayesian meta-analysis (pairwise and network) of randomized clinical trials.
• Inclusion of studies evaluating catheter-based therapies versus standard anticoagulation with or without systemic thrombolysis.
• Assessment of all-cause mortality, major bleeding, hospital length of stay, and RV/LV ratio changes.

Main Results:

• This section will present the synthesized findings from the meta-analysis, comparing catheter-based interventions against control groups.
• Results will focus on the primary outcome of all-cause mortality and key secondary outcomes like major bleeding.
• Credible intervals will quantify the uncertainty around effect estimates.

Conclusions:

• This review will provide a comprehensive synthesis of evidence on catheter-based treatments for intermediate-high risk PE.
• Findings are expected to inform clinical guidelines and identify areas for future research.
• The study aims to clarify the role of these minimally invasive strategies in managing acute PE.