RT Journal Article
SR Electronic
T1 Catheter-directed thrombolysis compared with systemic thrombolysis and anticoagulation in patients with intermediate- or high-risk pulmonary embolism: systematic review and network meta-analysis
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E833
OP E843
DO 10.1503/cmaj.220960
VO 195
IS 24
A1 Planer, David
A1 Yanko, Stav
A1 Matok, Ilan
A1 Paltiel, Ora
A1 Zmiro, Rama
A1 Rotshild, Victoria
A1 Amir, Offer
A1 Elbaz-Greener, Gabby
A1 Raccah, Bruria Hirsh
YR 2023
UL http://www.cmaj.ca/content/195/24/E833.abstract
AB Background: Therapeutic options for intermediate- or high-risk pulmonary embolism (PE) include anticoagulation, systemic thrombolysis and catheter-directed thrombolysis (CDT); however, the role of CDT remains controversial. We sought to compare the efficacy and safety of CDT with other therapeutic options using network meta-analysis.Methods: We searched PubMed (MEDLINE), Embase, ClinicalTrials.gov and Cochrane Library from inception to Oct. 18, 2022. We included randomized controlled trials and observational studies that compared therapeutic options for PE, including anticoagulation, systemic thrombolysis and CDT among patients with intermediate- or high-risk PE. The efficacy outcome was in-hospital death. Safety outcomes included major bleeding, intracerebral hemorrhage and minor bleeding.Results: We included data from 44 studies, representing 20 006 patients. Compared with systemic thrombolysis, CDT was associated with a decreased risk of death (odd ratio [OR] 0.43, 95% confidence interval [CI] 0.32–0.57), intracerebral hemorrhage (OR 0.44, 95% CI 0.29–0.64), major bleeding (OR 0.61, 95% CI 0.53–0.70) and blood transfusion (OR 0.46, 95% CI 0.28–0.77). However, no difference in minor bleeding was observed between the 2 therapeutic options (OR 1.11, 95% CI 0.66–1.87). Compared with anticoagulation, CDT was also associated with decreased risk of death (OR 0.36, 95% CI 0.25–0.52), with no increased risk of intracerebral hemorrhage (OR 1.33, 95% CI 0.63–2.79) or major bleeding (OR 1.24, 95% CI 0.88–1.75).Interpretation: With moderate certainty of evidence, the risk of death and major bleeding complications was lower with CDT than with systemic thrombolysis. Compared with anticoagulation, CDT was associated with a probable lower risk of death and a similar risk of intracerebral hemorrhage, with moderate certainty of evidence. Although these findings are largely based on observational data, CDT may be considered as a first-line therapy in patients with intermediate- or high-risk PE. Protocol registration: PROSPERO — CRD42020182163