Efficacy and safety outcomes of recanalization procedures in patients with acute symptomatic pulmonary embolism: systematic review and network meta-analysis.
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2017
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Thorax
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Abstract
Background We aimed to review the efficacy and
safety of recanalisation procedures for the treatment of
PE.
Methods 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 randomeffects
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.
Results 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 catheterdirected
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.
Conclusions 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
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Keywords
Pulmonary embolism, Systematic review