Short term effect of recombinant tissue plasminogen activator in patients with hemodynamically stable acute pulmonary embolism: results of a meta-analysis involving 464 patients.

B. Tardy 1 C. Venet F. Zeni M. Coudrot S. Guyomarc'H P. Mismetti 1
1 GRT (EA 3065) - Groupe de recherche sur la thrombose
Abstract : By considering studies where a mixing of patients with and without shock, with or without invasive procedure, treated with various thrombolytic agents through different ways of infusion, have been included, current meta-analyses on thrombolysis efficacy in Pulmonary embolism (PE) are of limited value. Modern management of PE includes the use of both non-invasive diagnostic methods and intravenous rt-PA as thrombolytic agent. METHODS: We performed a meta-analysis of all randomized trials comparing rt-PA with heparin in patients with hemodynamically stable pulmonary embolism. Only the events clearly identified as related with the venous thromboembolic disease or with the treatment were considered. RESULTS: Five studies involving 464 patients were included. The pooled estimate from all the trials revealed a non-statistically significant reduction in death related to PE or pulmonary recurrence for rt-PA compared with heparin (3.5% versus 4.6%; RR 0.97, 95% CI 0.38 to 2.51, P for heterogeneity among the studies=0.73). Compared with heparin, rt-PA was not associated with a significant increase in major bleeding (4.9% versus 4.6%; RR 0.94, 95% CI 0.39 to 2.27). Similar results were found when only studies including patients with echocardiographic evidence of right ventricular dysfunction were considered. CONCLUSION: Neither mortality due to pulmonary embolism nor objective pulmonary embolism recurrence are decreased by rt-PA compared with heparin in patients with hemodynamically stable pulmonary embolism. No benefit is suggested in studies including patients with right ventricular dysfunction alone.
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Submitted on : Tuesday, December 8, 2009 - 2:27:31 PM
Last modification on : Sunday, October 15, 2017 - 10:44:04 PM

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B. Tardy, C. Venet, F. Zeni, M. Coudrot, S. Guyomarc'H, et al.. Short term effect of recombinant tissue plasminogen activator in patients with hemodynamically stable acute pulmonary embolism: results of a meta-analysis involving 464 patients.. Thrombosis Research, Elsevier, 2009, 124 (6), pp.672-7. ⟨10.1016/j.thromres.2009.05.009⟩. ⟨ujm-00439716⟩

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