Comparison Of Thrombolysis And Anticoagulation In Submassive Pulmonary Embolism:a Meta-analysis

Background: The mortality rate of pulmonary embolism varies dramaticallywith the severity of the disease. The treatment strategy is performing treatmentaccording to the risk stratification. Consensus has been reached in the treatment ofmassive pulmonary embolism which is defined by the presence of sustainedhypotension. In hemodynamically stable patients, it has been found thatechocardiography, CT scan, biomarkers and other methods can be used for riskstratification. There is not adequate high-quality evidence that thrombolytic therapyhas better efficacy and safety than anticoagulation in the treatment of submassivepulmonary embolism patients which is classified by the above methods.Objective: To compare the efficacy and safety between thrombolysis andanticoagulation in submassive pulmonary embolism.Methods: PubMed, EMbase, CENTRAL and CBM were searched by computerto collect randomized controlled trails which compared the efficacy and safetybetween thrombolysis and anticoagulation in submassive pulmonary embolism. Theassessment of methodological quality and data extraction were performed in line withthe selection criteria.Review Manager5.1software was used to carry outMeta-analysis. The outcomes contain death, recurrence of pulmonary embolism and major haemorrhagic events.Results:4studies with432patients were enrolled.Because of the differentmethod of risk stratification, the studies were divided into two subgroups, theechocardiography subgroup and the mix subgroup.In the echocardiography subgroup,the RR of mortality rate compared with anticoagulation was0.14(95%CI,0.03-0.76),the RR of recurrence rate was0.17(95%,0.04-0.72), the RR of major haemorrhagicevents rate was2.01(95%CI,0.38-10.61). There was non-significant difference ofthe three outcomes in the mix subgroup and total group.Conclusion: Echocardiography can be used for the risk stratification insubmassive pulmonary embolism. Electrocardiogram and catheterization may not beused for the risk stratification.Compared with anticoagulation, thrombolysis has betterefficacy and similar safety in submassive pulmonary embolism.