Catheter-directed Thrombolysis versus Systemic Anticoagulation for Submassive Pulmonary Embolism: A Meta-Analysis

• Published in: Current cardiology reviews Vol. 18; no. 1; pp. 112 - 117
• Main Authors: Siordia, Juan Arturo, Kaur, Amanpreet
• Format: Journal Article
• Language: English
• Published: United Arab Emirates Benham Science Publishers 01-01-2022; Bentham Science Publishers
• Subjects: Anticoagulants; Anticoagulants - therapeutic use; Bleeding; Catheters; Embolism; Fibrinolytic Agents - therapeutic use; Humans; Medical instruments; Meta-analysis; Mortality; Pulmonary Embolism - drug therapy; Pulmonary embolisms; Search engines; Thrombolysis; Thrombolytic Therapy - methods; Treatment Outcome; heparin; Submassive pulmonary embolism; catheter-directed thrombolysis; hemodynamic instability; systematic anticoagulation; thrombolytic
• ISSN: 1573-403X; 1875-6557
• DOI: 10.2174/1573403X17666210603114116

The optimal therapy for submassive pulmonary embolism remains in question. The following meta-analysis compiles the current evidence comparing Catheter-Directed Thrombolysis (CDT) versus Systemic Anticoagulation (SA).
An electronic search through PubMed and Google scholar revealed studies comparing CDT versus SA in terms of mortality and major bleeding events. Thirty-day, 90-day, and one-year mortality results were analyzed.
Six studies were included in the meta-analysis. Thirty-day and one-year mortality were less with CDT compared to SA (OR 0.27 [CI 0.11-0.67]; and OR 0.50 [CI 0.28-0.89]). Ninety-day mortality was similar between the two methods (OR 0.57 [CI 0.17-1.92]). Compilation of all studies reporting at least greater than 30-day mortality revealed less mortality with CDT (OR 0.51 [0.30-0.86]). Major bleeding was similar between the two treatments (OR 1.63 [CI 0.63-4.20]).
CDT has less 30-day and 1-year mortality with equivalent rates of major bleeding compared to SA for treatment of submassive pulmonary embolism.