The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding).
A Cochrane review [Abstract] 1 included 21 studies with a total of 2 401 subjects to assess the effects of thrombolytic therapy for acute pulmonary embolism (PE). No studies compared thrombolytics versus surgical intervention.
Thrombolytics plus heparin compared to heparin alone, or heparin plus placebo reduced mortality (OR 0.58, 95% CI 0.38 to 0.88; 19 studies, n=2 319) and recurrence of pulmonary embolism (PE) (OR 0.54, 95% CI 0.32 to 0.91; 12 studies, n=2 050). The effects of death weakened when 6 studies at high risk of bias were excluded from analysis (OR 0.71, 95% CI 0.45 to 1.13, 13 studies, n=2 046) and in the analysis of submassive PE participants (OR 0.61, 95% CI 0.37 to 1.02; n=1 993). The incidence of major (OR 2.84, 95% CI 1.92 to 4.20; 15 studies, n=2 101) and minor haemorrhagic events (OR 2.97, 95% CI 1.66 to 5.30, statistical heterogeneity I2 =55%; 13 studies, n=1 757 ) was higher in the thrombolytics group than in the control group. Haemorrhagic stroke occured more often in the thrombolytics group than in the control group (OR 7.59, 95% CI 1.38 to 41.72; 2 studies, n=1 091).
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