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Université Jean Monnet – Saint-Etienne |  |
Journal articles
Short term effect of recombinant tissue plasminogen activator in patients with hemodynamically stable acute pulmonary embolism: results of a meta-analysis involving 464 patients.
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.
https://hal-ujm.archives-ouvertes.fr/ujm-00439716
Contributor : Patrick Mismetti Connect in order to contact the contributor
Submitted on : Tuesday, December 8, 2009 - 2:27:31 PM
Last modification on : Thursday, November 21, 2019 - 2:30:15 AM
Contributor : Patrick Mismetti Connect in order to contact the contributor
Submitted on : Tuesday, December 8, 2009 - 2:27:31 PM
Last modification on : Thursday, November 21, 2019 - 2:30:15 AM