Thrombolysis in stable PE

 Meta-analysis was done to determine mortality benefits and bleeding risks associated with thrombolytic therapy compared with anticoagulation in acute pulmonary embolism, including the subset of hemodynamically stable patients with right ventricular dysfunction (intermediate-risk pulmonary embolism).

Study Selection  Eligible studies were randomized clinical trials comparing thrombolytic therapy vs anticoagulant therapy in pulmonary embolism patients. Sixteen trials comprising 2115 individuals were identified. Eight trials comprising 1775 patients specified inclusion of patients with intermediate-risk pulmonary embolism.

Outcomes  

• Primary outcomes were all-cause mortality and major bleeding.
• Secondary outcomes were risk of recurrent embolism and intracranial hemorrhage (ICH).

Results  

• Use of thrombolytics was associated with lower all-cause mortality ( 2.17% vs 3.89% ] 
•  greater risks of major bleeding 9.24%  vs 3.42%
•  ICH  1.46% vs 0.19%
• Major bleeding was not significantly increased in patients 65 years and younger 
• Thrombolysis was associated with a lower risk of recurrent pulmonary embolism ( 1.17%  vs 3.04%).

Conclusions  Among patients with pulmonary embolism, including those who were hemodynamically stable with right ventricular dysfunction, thrombolytic therapy was associated with lower rates of all-cause mortality but increased risks of major bleeding and ICH. However, findings may not apply to patients with pulmonary embolism who are hemodynamically stable without right ventricular dysfunction.

Thrombolysis for Pulmonary Embolism and Risk of All-Cause Mortality, Major Bleeding, and Intracranial Hemorrhage A Meta-analysis - Saurav Chatterjee; Anasua Chakraborty; Ido Weinberg; Mitul Kadakia; Robert L. Wilensky; Partha Sardar; Dharam J. Kumbhani, MD,; Debabrata Mukherjee, MD, MS5; Michael R. Jaff; Jay Giri, MD - JAMA. 2014;311(23):2414-2421