Meta-Analysis Of The Efficacy And Safety Of Initial Thrombolytic Sequential Anticoagulant Therapy And Simple Anticoagulant Therapy In Intermediate-High Risk Pulmonary Thromboembolism

Objective: To explore the effect of initial thrombolytic sequential anticoagulant therapy and simple anticoagulant therapy on the efficacy and safety of patients with intermediate-high risk pulmonary thromboembolism.Methods: The relevant research documents of English databases such as Pub Med,Cochrane Library,Embase,Medline,and Chinese databases such as CNKI,Wanfang Database,and CBM have been systematically searched until July 2022.After reading the title and abstract,conduct the preliminary screening,and read the full text and then conduct the secondary screening.The patients with intermediate-high risk pulmonary thromboembolism were selected as the study subjects,the initial thrombolytic sequential anticoagulation treatment was the observation group,and the simple anticoagulation treatment was the control group,containing the literature of therapeutic efficacy and safety as the outcome.The data of randomized controlled trials that meet the requirements are included in the meta-analysis.Revman 5.4.1 software is used for quality evaluation,heterogeneity test,bias risk detection and data analysis of the included studies.The main end points included efficacy(effective rate,recurrence rate,case fatality rate)and safety(massive bleeding rate and clinically related non-massive bleeding rate).Relative risk(RR)and clinically relevant 95% confidence interval(95%confidence interval,95% CI)are determined by binary variables.Results: In this paper,a total of 2322 subjects were included in 16 studies,1158 in the thrombolytic sequential anticoagulation treatment group and 1164 in the simple anticoagulation group.The results showed that compared with the initial simple anticoagulation therapy,the initial thrombolytic sequential anticoagulation therapy had a higher effective rate[RR=1.27,95% CI(1.17,1.38),P<0.00001],a lower recurrence rate[RR=0.41,95% CI(0.21,0.79),P=0.007],and a lower mortality rate[RR=0.55,95% CI(0.33,0.91),P=0.02].However,the incidence of massive hemorrhage and clinically related non-massive hemorrhage was higher[RR=2.92,95% CI(1.84,4.65),P<0.00001] [RR=1.75,95% CI(1.10,2.77),P=0.02].Conclusions: Compared with simple anticoagulation therapy,initial thrombolytic sequential anticoagulant therapy for patients with intermediate-high risk pulmonary thromboembolism can improve the treatment efficiency to a certain extent,reduce the recurrence rate and mortality,but it will bring higher bleeding risk to patients.