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Safety and efficacy of clot-dissolving therapies for submassive pulmonary embolism: A network meta-analysis of randomized controlled trials.
- Source :
-
Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2024 May; Vol. 62, pp. 73-81. Date of Electronic Publication: 2023 Dec 21. - Publication Year :
- 2024
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Abstract
- Background: Acute pulmonary embolism (PE) is a serious condition that needs quick and effective treatment. Anticoagulation therapy is the usual care for most PE patients but may not work well for higher-risk ones. Thrombolysis breaks the clot and improves blood flow. It can be given systemically or locally. Ultrasound-assisted catheter-directed thrombolysis (USAT) is a new technique that boosts clot-busting drugs. This network meta-analysis compares death, bleeding, and benefits of four treatments in acute submassive PE.<br />Methods: We comprehensively searched relevant databases up to July 2023 for RCTs. The outcomes encompassed all-cause mortality, major and minor bleeding, PE recurrence, and hospital stay duration. Bayesian network meta-analysis computed odds ratios (OR) and 95 % CI estimates.<br />Results: In this network meta-analysis of 23 RCTs involving 2521 PE patients, we found that SCDT had the most favorable performance for mortality, as it had the lowest odds ratio (OR) among the four interventions (OR 5.41e-42; 95 % CI, 5.68e-97, 1.37e-07). USAT had the worst performance for major bleeding, as it had the highest OR among the four interventions (OR 4.73e+04; 95 % CI, 1.65, 9.16e+13). SCDT also had the best performance for minor bleeding, as it had the lowest OR among the four interventions (OR 5.68e-11; 95 % CI, 4.97e-25, 0.386).<br />Conclusion: Our meta-analysis suggests that SCDT is the most effective treatment intervention in improving the risks of All-cause mortality and bleeding. Thrombolytic therapy helps in improving endpoints including the risk of PE recurrence and the duration of hospital stay.<br />Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.<br /> (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Treatment Outcome
Risk Factors
Male
Female
Aged
Risk Assessment
Middle Aged
Time Factors
Adult
Ultrasonic Therapy adverse effects
Aged, 80 and over
Length of Stay
Anticoagulants adverse effects
Anticoagulants administration & dosage
Pulmonary Embolism mortality
Pulmonary Embolism drug therapy
Pulmonary Embolism diagnostic imaging
Pulmonary Embolism therapy
Pulmonary Embolism diagnosis
Randomized Controlled Trials as Topic
Network Meta-Analysis
Thrombolytic Therapy adverse effects
Thrombolytic Therapy mortality
Fibrinolytic Agents adverse effects
Fibrinolytic Agents administration & dosage
Hemorrhage chemically induced
Recurrence
Subjects
Details
- Language :
- English
- ISSN :
- 1878-0938
- Volume :
- 62
- Database :
- MEDLINE
- Journal :
- Cardiovascular revascularization medicine : including molecular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 38176962
- Full Text :
- https://doi.org/10.1016/j.carrev.2023.12.011