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

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.