Respiratory Department, Hospital Ramón y Cajal, Madrid, Spain.
Medicine Department, Universidad de Alcala (IRYCIS), Alcalá de Henares, Spain.
Thorax. 2018 May;73(5):464-471. doi: 10.1136/thoraxjnl-2017-210040. Epub 2017 Nov 13.
We aimed to review the efficacy and safety of recanalisation procedures for the treatment of PE.
We searched PubMed, the Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through 31 July 2015 and included randomised clinical trials that compared the effect of a recanalisation procedure versus each other or anticoagulant therapy in patients diagnosed with PE. We used network meta-analysis and multivariate random-effects meta-regression to estimate pooled differences between each intervention and meta-regression to assess the association between trial characteristics and the reported effects of recanalisation procedures versus anticoagulation.
For all-cause mortality, there were no significant differences in event rates between any of the recanalisation procedures and anticoagulant treatment (full-dose thrombolysis: OR 0.60; 95% CI0.36 to 1.01; low-dose thrombolysis: 0.47; 95% CI 0.14 to 1.59; and catheter-associated thrombolysis: 0.31; 95% CI 0.01 to 7.96). Full-dose thrombolysis increased the risk of major bleeding (2.00; 95% CI 1.06 to 3.78) compared with anticoagulation. Catheter-directed thrombolysis was associated with the lowest probability of dying (surface under the cumulative ranking curve (SUCRA), 0.67), followed by low-dose thrombolysis (SUCRA, 0.66) and full-dose thrombolysis (SUCRA, 0.55). Similarly, low-dose thrombolysis was associated with the lowest probability of major bleeding (SUCRA, 0.61), followed by catheter-directed thrombolysis (SUCRA, 0.54) and full-dose thrombolysis (SUCRA, 0.17). The results were similar in sensitivity analyses based on restricting only to studies in haemodynamically stable patients with PE.
In the treatment of PE, recanalisation procedures do not seem to offer a clear advantage compared with standard anticoagulation. Low-dose thrombolysis was associated with the lowest probability of dying and bleeding.
PROSPERO CRD42015024670.
我们旨在回顾经导管介入溶栓术治疗肺栓塞（PE）的有效性和安全性。
我们检索了从建库至 2015 年 7 月 31 日的 PubMed、Cochrane 图书馆、EMBASE、EBSCO、Web of Science 和 CINAHL 数据库，纳入比较经导管介入溶栓术与其他溶栓方法或抗凝治疗对 PE 患者疗效的随机对照临床试验。采用网状 Meta 分析和多变量随机效应 Meta 回归估计每种干预措施之间的差异，Meta 回归评估试验特征与经导管介入溶栓术与抗凝治疗相比的疗效之间的关系。
全因死亡率方面，任何经导管介入溶栓术与抗凝治疗之间的事件发生率均无显著差异（全剂量溶栓：OR0.60；95%CI0.36 至 1.01；低剂量溶栓：0.47；95%CI0.14 至 1.59；导管相关溶栓：0.31；95%CI0.01 至 7.96）。与抗凝治疗相比，全剂量溶栓增加了大出血风险（2.00；95%CI1.06 至 3.78）。与其他治疗方法相比，导管内溶栓导致死亡的概率最低（累积排序曲线下面积（SUCRA），0.67），其次是低剂量溶栓（SUCRA，0.66）和全剂量溶栓（SUCRA，0.55）。同样，低剂量溶栓导致大出血的概率最低（SUCRA，0.61），其次是导管内溶栓（SUCRA，0.54）和全剂量溶栓（SUCRA，0.17）。仅纳入血流动力学稳定的 PE 患者的研究进行敏感性分析后，结果类似。
在治疗 PE 时，与标准抗凝治疗相比，经导管介入溶栓术似乎没有明显优势。低剂量溶栓导致死亡和出血的概率最低。
PROSPERO CRD42015024670。
