Alcedo Pedro E, García-Perdomo Herney Andrés, Rojas-Hernandez Cristhiam M
Internal Medicine Department The University of Texas McGovern Medical School Houston Texas.
Department of Surgery/Urology Universidad del Valle School of Medicine Cali Colombia.
EJHaem. 2020 Sep 3;1(2):457-466. doi: 10.1002/jha2.97. eCollection 2020 Nov.
Benefit of thrombolytic therapy in patients with massive pulmonary embolism (PE) is evident. However, evidence supporting benefit in clinical outcomes of this approach in intermediate risk PE is lacking.
To determine the impact of thrombolysis on overall survival in intermediate risk PE patients.
We searched in MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from present day. We also searched in other databases and unpublished literature. We included clinical trials without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. The primary outcome was overall survival. Secondary outcomes were adverse events, including major bleeding, and all-cause mortality. The measure of the effect was the risk ratio with a 95% confidence interval (CI).
We included 11 studies in the qualitative and quantitative analysis, with a total of 1855 patients. Risk of bias was variable among the study items. There were no results reported about overall survival in any of the studies. The risk ratio (RR) for all-cause mortality was 0.68 95% CI (0.40 to 1.16). The RR of overall bleeding, major bleeding and stroke were 2.72 95% CI (1.58 to 4.69), 2.17 95% CI (1.03 to 4.55), and 2.22 95% CI (0.17 to 28.73), respectively. Additionally, the RR for recurrent PE was 0.56 95% CI (0.23 to 1.37).
In patients with intermediate risk PE, the risk of bleeding is higher when thrombolysis is used. There was no significant difference between thrombolysis and anticoagulation in recurrence of PE, stroke, and all-cause mortality.
溶栓疗法对大面积肺栓塞（PE）患者的益处是显而易见的。然而，缺乏支持这种方法对中危PE患者临床结局有益的证据。
确定溶栓对中危PE患者总生存期的影响。
我们从即日起在MEDLINE（OVID）、EMBASE、LILACS和Cochrane对照试验中央注册库（CENTRAL）中进行检索。我们还检索了其他数据库和未发表的文献。纳入无语言限制的临床试验。使用Cochrane协作工具评估偏倚风险。主要结局是总生存期。次要结局是不良事件，包括大出血和全因死亡率。效应量的测量指标是风险比及95%置信区间（CI）。
我们纳入了11项研究进行定性和定量分析，共1855例患者。各研究项目的偏倚风险各不相同。所有研究均未报告总生存期的结果。全因死亡率的风险比（RR）为0.68，95%CI（0.40至1.16）。总出血、大出血和卒中的RR分别为2.72，95%CI（1.58至4.69）；2.17，95%CI（1.03至4.55）；以及2.22，95%CI（0.17至28.73）。此外，复发性PE的RR为0.56，95%CI（0.23至1.37）。
在中危PE患者中，使用溶栓治疗时出血风险更高。在PE复发、卒中及全因死亡率方面，溶栓与抗凝之间无显著差异。
