Thrombolytics for venous thromboembolic events: a systematic review with meta-analysis
| Autor: | Walter Ageno, Liming Lu, Jiaming Wu, Gabriel Rada, Daniel M. Witt, Holger J. Schünemann, Veena Manja, Peter Verhamme, Juan Martín Criniti, Sam Schulman, Ariel Izcovich, Yuqing Zhang, Federico Popoff, Michael R. Jaff, Ignacio Neumann, Wojtek Wiercioch, Robby Nieuwlaat |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
CONTROLLED CLINICAL-TRIAL medicine.medical_treatment POSTTHROMBOTIC SYNDROME MEDLINE SUBMASSIVE PULMONARY-EMBOLISM 030204 cardiovascular system & hematology CATHETER-DIRECTED THROMBOLYSIS law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Humans 030212 general & internal medicine DEEP-VEIN THROMBOSIS Venous Thrombosis Science & Technology business.industry Heparin Anticoagulants Thrombolysis Venous Thromboembolism Hematology Heparin Low-Molecular-Weight RT-PA medicine.disease Confidence interval TISSUE PLASMINOGEN-ACTIVATOR RANDOMIZED-TRIAL Pulmonary embolism Venous thrombosis Relative risk Meta-analysis HEPARIN STREPTOKINASE Systematic Review business Life Sciences & Biomedicine |
| Popis: | Thrombolytic therapy might reduce venous thromboembolism-related mortality and morbidity, but it could also increase the risk of major bleeding. We systematically reviewed the literature to evaluate the effectiveness and safety of thrombolytics in patients with pulmonary embolism (PE) and/or deep venous thrombosis (DVT). We searched Medline, Embase, and Cochrane databases for relevant randomized controlled trials up to February 2019. Multiple investigators independently screened and collected data. We included 45 studies (4740 participants). Pooled estimates of PE studies indicate probable reduction in mortality with thrombolysis (risk ratio [RR], 0.61; 95% confidence interval [CI], 0.40-0.94) (moderate certainty) and possible reduction in nonfatal PE recurrence (RR, 0.56; 95% CI, 0.35-0.89) (low certainty). Pooled estimates of DVT studies indicate the possible absence of effects on mortality (RR, 0.77; 95% CI, 0.26-2.28) (low certainty) and recurrent DVT (RR, 0.99; 95% CI, 0.56-1.76) (low certainty), but possible reduction in postthrombotic syndrome (PTS) with thrombolytics (RR, 0.70; 95% CI, 0.59-0.83) (low certainty). Pooled estimates of the complete body of evidence indicate increases in major bleeding (RR, 1.89; 95% CI, 1.46-2.46) (high certainty) and a probable increase in intracranial bleeding (RR, 3.17; 95% CI 1.19-8.41) (moderate certainty) with thrombolytics. Our findings indicate that thrombolytics probably reduce mortality in patients with submassive- or intermediate-risk PE and may reduce PTS in patients with proximal DVT at the expense of a significant increase in major bleeding. Because the balance between benefits and harms is profoundly influenced by the baseline risks of critical outcomes, stakeholders involved in decision making would need to weigh these effects to define which clinical scenarios merit the use of thrombolytics. ispartof: BLOOD ADVANCES vol:4 issue:7 pages:1539-1553 ispartof: location:United States status: published |
| Databáze: | OpenAIRE |
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