Thrombolysis Vs Anticoagulation For The Initial Treatment Of Moderate Pulmonary Embolism:a Meta-analysis Of The RCT

Background In patients with moderate pulmonary embolism（PE）, therisk benefit ratio of thrombolytic therapy or anticoagulant therapy havereached conflicting conclusions in randomized trials and meta-analyses. Inorder to know the effect of initial thrombolysis or anticoagulation therapyin patients with moderate PE, we performed an update meta-analysis.Methods We searched foreign databases, the Cochrane library, andChinese databases for randomized controlled trials （RCT） focusing on theeffect of initial thrombolysis or anticoagulation therapy in patientsmoderate PE. Then, we used a meta-analysis of all randomized trialscomparing thrombolytic therapy with heparin in patients with moderatepulmonary embolism.Results Fifteen trials, involving1247patients, were included.Compared with anticoagulation, thrombolytic therapy was associated witha significant reduction in recurrent pulmonary embolism or death （1.94%versus5.87%；OR0.37，95%CI0.21to0.66, P for heterogeneity₀.49）, anon-significant increase in major bleeding （3.57%versus2.67%；OR1.34，95%CI0.70to2.58）, but a significant increase in nonmajor bleeding （12.78%versus3.65%；OR4.12，95%CI2.37to7.17）. Thrombolysis wasassociated with a significant reduction in recurrent pulmonary embolism ordeath in trials that enrolled both foreign patients （3.46%versus7.76%；OR0.45，95%CI0.23to0.86） as well as our national patients （0.00%versus3.72%；OR0.18，95%CI0.05to0.73）with moderate pulmonary embolismcomparing anticoagulation, non-significant heterogeneity existed betweenthese2groups of trials （P₀.12）. Thrombolysis was associated with anon-significant reduction in recurrent pulmonary embolism or death intrialsS that enrolled Follow-up＜1month （2.67%versus4.46%；OR0.62，95%CI0.29to1.36）,while with a significant reduction in trials thatenrolled Follow-up≥1month（1.07%versus8.12%；OR0.20，95%CI0.08to0.50）with moderate pulmonary embolism comparing anticoagulation,significant heterogeneity existed between these2groups of trials （P₀.03）.Conclusions Compared with anticoagulation therapy, both mortalityand pulmonary embolism recurrence are decreased by thrombolysis inpatients with moderate pulmonary embolism, the risk of nonmajor bleedingis increased, but the risk of major bleeding is not increased.