Pulmonary Vascular Disease |

Efficacy and Safety of Thrombolysis in Pulmonary Embolism: A Meta-analysis FREE TO VIEW

Adil Shujaat; Abubakr Bajwa
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University of Florida, Jacksonville, FL

Chest. 2014;146(4_MeetingAbstracts):831A. doi:10.1378/chest.1995123
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Previous meta-analyses of randomized clinical trials (RCT) of thrombolysis compared with heparin for the treatment of pulmonary embolism (PE) have been under-powered to detect a difference in mortality. The recent announcement of the results of PEITHO, the largest ever RCT of thrombolysis compared with heparin in PE, warrants an updated meta-analysis.

METHODS: We searched for prospective, randomized, placebo controlled, clinical trials of thrombolysis compared with heparin for the treatment of PE in PUBMED, among reference lists of the initially identified articles, and among abstracts presented at international scientific meetings. Outcomes of interest were mortality and major bleeding, including intracranial bleeding. We used fixed effects model to perform the meta-analysis.

RESULTS: Fifteen RCTs involving 1966 patients were included. Thrombolysis compared with heparin was associated with a significant reduction in death (2.3% versus 3.97%; OR 0.59, 95% CI 0.36 to 0.97; number needed to treat: 62) and a significant increase in major bleeding (8.3% versus 3.6%; OR 2.37, 95%CI 1.58 to 3.55; number needed to harm: 21).

CONCLUSIONS: Thrombolysis compared with heparin for initial treatment in patients with PE reduces mortality but such benefit is outweighed by risk of major bleeding.

CLINICAL IMPLICATIONS: Thrombolysis can not be recommended for initial treatment in unselected patients with PE.

DISCLOSURE: The following authors have nothing to disclose: Adil Shujaat, Abubakr Bajwa

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