Recombinant tissue plasminogen activator for hemodynamically stable patients experiencing an acute pulmonary embolism: A meta-analysis

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• 作者：Yunfeng Liu^a ; Youjin Lu^a ; Jian Song^b ; Dan Li^c ; Hongyan Liu^a ; Jin Yang^a ; Hui Zhao^a ; ^{zhaohuichenxi2@126.com" class="auth_mail}
• 关键词：rt-PA ; recombinant tissue plasminogen activator ; RVD ; right ventricular dysfunction ; PE ; pulmonary embolism ; RR ; relative risk ; CI ; confidence interval ; CTPA ; computed tomography pulmonary angiography ; CT ; computed tomography ; FABPs ; fatty acid&ndash ; binding proteins ; PEITHO ; pulmonary embolism thrombolysis
• 刊名：Thrombosis Research
• 出版年：July 2014
• 年：2014
• 卷：134
• 期：1
• 页码：50-56
• 全文大小：786 K

文摘

The role of thrombolytic therapy for the initial treatment of hemodynamically stable patients experiencing an acute pulmonary embolism remains controversial.

Methods and Results

We performed a meta-analysis of randomized trials comparing between administration of recombinant tissue plasminogen activator (rt-PA) and heparin in hemodynamically stable patients experiencing an acute pulmonary embolism. Seven trials, involving 594 patients, were included in this meta-analysis. Compared with heparin, rt-PA was associated with a non-significant reduction in death (2.75% versus 3.96%; RR 0.69, 95% CI 0.31-1.52, P for heterogeneity = 0.520) and recurrent pulmonary embolism (2.13% versus 3.34%; RR 0.70, 95% CI 0.28-1.73), and a non-significant increase in major bleeding (5.15% versus 4.29%; RR 1.06, 95% CI 0.520-2.150). Similar results were found based on a subgroup analysis of patients displaying echocardiographic evidence of right ventricular dysfunction (RVD). In contrast, rt-PA treatment was associated with a significant reduction in escalation of care in trials that also enrolled patients displaying RVD compared with heparin treatment (6.56% versus 19.7%; RR 0.34, 95% CI 0.20-0.65).

Conclusion

The currently available data provide no evidence for a benefit of administration of rt-PA compared with heparin for the initial treatment of hemodynamically stable patients experiencing an acute pulmonary embolism. However, rt-PA is partially beneficial specifically among patients displaying RVD.