Jimenez D, et al. - This study involves a review of the efficacy and safety of recanalisation procedures for the treatment of PE. No clear advantage of recanalisation procedures vs standard anticoagulation appeared in the treatment of PE. Furthermore, it was noted that low-dose thrombolysis was associated with the lowest probability of dying and bleeding.

Methods

• PubMed, the Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases were searched from inception through 31 July 2015 to identify randomised clinical trials that compared the impact of a recanalisation procedure vs each other or anticoagulant therapy in patients diagnosed with PE.
• Using network meta-analysis and multivariate random-effects meta-regression, researchers estimated pooled differences between each intervention.
• They used meta-regression to evaluate the link between trial characteristics and the reported impacts of recanalisation procedures vs anticoagulation.

Results

• Data demonstrated that for all-cause mortality, there were no significant differences in event rates between any of the recanalisation procedures and anticoagulant treatment (full-dose thrombolysis: OR 0.60; 95% CI0.36 to 1.01; low-dose thrombolysis: 0.47; 95% CI 0.14 to 1.59; and catheter-associated thrombolysis: 0.31; 95% CI 0.01 to 7.96).
• Researchers noted that in comparison to anticoagulation, full-dose thrombolysis increased the risk of major bleeding (2.00; 95% CI 1.06 to 3.78).
• They also observed that catheter-directed thrombolysis was related to the lowest probability of dying (surface under the cumulative ranking curve (SUCRA), 0.67), followed by low-dose thrombolysis (SUCRA, 0.66) and full-dose thrombolysis (SUCRA, 0.55).
• Similarly, association of low-dose thrombolysis with the lowest probability of major bleeding (SUCRA, 0.61) was evident, followed by catheter-directed thrombolysis (SUCRA, 0.54) and full-dose thrombolysis (SUCRA, 0.17).
• Additionally, findings revealed that the results were similar in sensitivity analyses based on restricting only to studies in haemodynamically stable patients with PE.