TY - JOUR
T1 - Catheter directed compared to systemically delivered thrombolysis for pulmonary embolism
T2 - a systematic review and meta-analysis
AU - Pasha, Ahmed K.
AU - Siddiqui, Muhammad Umer
AU - Siddiqui, Muhammad Danial
AU - Ahmed, Adnan
AU - Abdullah, Ammar
AU - Riaz, Irbaz
AU - Murad, M. Hassan
AU - Bjarnason, Haraldur
AU - Wysokinski, Waldemar E.
AU - McBane, Robert D.
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022/2
Y1 - 2022/2
N2 - To compare the efficacy and safety of systemic and catheter directed thrombolysis for patients with pulmonary embolism. Pubmed and Cochrane Central Register of Controlled Trials were systematically searched from inception to May 31st 2020 to identify relevant studies. Outcomes of interest were in-hospital mortality and major bleeding including intracranial hemorrhage. We included 8 observational studies comprising 11,932 patients with PE. Catheter directed thrombolysis was associated with lower in-hospital mortality [RR 0.52; 95% confidence interval (CI) 0.40–0.68]. Although there was no difference in major bleeding by treatment strategy (RR 0.80; 95% CI 0.37–1.76), intracranial hemorrhage was lower in patients receiving catheter directed therapy (RR 0.66; 95% CI, 0.47–0.94).The certainty in these estimates was low. Non-randomized studies suggest that catheter directed delivery of thrombolytic therapy may be associated with lower in-hospital mortality and intracranial hemorrhage rates. These results may help inform management strategies for health care and pulmonary embolism response teams (PERT) involved in the management of high risk patients with massive or submassive pulmonary emboli.
AB - To compare the efficacy and safety of systemic and catheter directed thrombolysis for patients with pulmonary embolism. Pubmed and Cochrane Central Register of Controlled Trials were systematically searched from inception to May 31st 2020 to identify relevant studies. Outcomes of interest were in-hospital mortality and major bleeding including intracranial hemorrhage. We included 8 observational studies comprising 11,932 patients with PE. Catheter directed thrombolysis was associated with lower in-hospital mortality [RR 0.52; 95% confidence interval (CI) 0.40–0.68]. Although there was no difference in major bleeding by treatment strategy (RR 0.80; 95% CI 0.37–1.76), intracranial hemorrhage was lower in patients receiving catheter directed therapy (RR 0.66; 95% CI, 0.47–0.94).The certainty in these estimates was low. Non-randomized studies suggest that catheter directed delivery of thrombolytic therapy may be associated with lower in-hospital mortality and intracranial hemorrhage rates. These results may help inform management strategies for health care and pulmonary embolism response teams (PERT) involved in the management of high risk patients with massive or submassive pulmonary emboli.
KW - Catheter directed thrombolysis
KW - Pulmonary embolism
KW - Systemic thrombolysis
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U2 - 10.1007/s11239-021-02556-7
DO - 10.1007/s11239-021-02556-7
M3 - Article
C2 - 34463919
AN - SCOPUS:85113979704
SN - 0929-5305
VL - 53
SP - 454
EP - 466
JO - Journal of Thrombosis and Thrombolysis
JF - Journal of Thrombosis and Thrombolysis
IS - 2
ER -