Alternative recanalization interventions showed no benefit to all-cause mortality compared with standard anticoagulation in patients with acute pulmonary embolism, according to study results published in Annals of Emergency Medicine.

All-cause mortality end points were evaluated from literature searches for randomized controlled trials in the Cochrane Library, PubMed, EMBASE, EBSCO, Web of Science, and Cumulative Index of Nursing and Allied Health databases. One investigator performed the search and screening of potential articles for initial consideration, while 2 investigators independently reviewed studies for meta-analysis inclusion.

Interventions consisted of recanalization with full-dose thrombolysis, reduced-dose thrombolysis, or catheter-directed thrombolysis.

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Of the 930 initial search hits, 22 randomized controlled trials totaling 2494 patients were included in the analysis. Of these 22 trials, 16 compared full-dose thrombolysis with anticoagulation alone, 1 compared reduced-dose thrombolysis with anticoagulation alone, 1 compared ultrasonographically assisted catheter-directed thrombolysis with anticoagulation alone, and 4 compared full-dose thrombolysis with reduced-dose thrombolysis. Network meta-analysis found no reduction in all-cause mortality for full-dose thrombolysis, reduced-dose thrombolysis, and catheter-directed thrombolytics. Furthermore, full-dose thrombolysis increased major bleeding compared with anticoagulation alone (odds ratio, 2.00; 95% CI, 1.06-3.78).

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The researchers wrote, “This network meta-analysis found that full-dose, reduced-dose, and catheter-directed thrombolysis did not decrease all-cause mortality compared with anticoagulation alone, likely because of lack of statistical power and presence of wide confidence intervals.”


Long B, April MD. Are recanalization interventions effective and safe in the treatment of acute pulmonary embolism? [published March 14, 2019]. Ann Emerg Med. doi:10.1016/j.annemergmed.2019.01.008