Catheter-directed thrombolysis trumps systemic anticoagulation for submassive pulmonary embolism

Catheter-directed thrombolysis (CDT) is superior to systemic anticoagulation (SA) for the treatment of submassive pulmonary embolism (sPE), leading to better mortality rates without additional safety signals, a recent meta-analysis has found.

Drawing from the online databases of PubMed, Embase, Google Scholar, Cochrane, and ClinicalTrials.gov, researchers analysed 12 studies, of which 11 were observational in nature while one employed a randomized design. The cumulative sample included 9,789 patients in whom the outcomes of in-hospital, 30-day, 90-day, and 1-year mortality were assessed according to treatment received.

Pooled analysis revealed that CDT significantly lowered in-hospital mortality risk as opposed to SA (risk ratio [RR], 0.41, 95 percent confidence interval [CI], s0.30–0.56; p<0.00001). This significant benefit was also apparent for 30-day (RR, 0.37, 95 percent CI, 0.18–0.73; p=0.004) and 90-day (RR, 0.36, 95 percent CI, 0.17–0.72; p=0.004) mortality.

Similarly, CDT reduced 1-year mortality risk by over 40 percent, but this effect was only of borderline significance (RR, 0.56, 95 percent CI, 0.29–1.05; p=0.07).

These survival benefits did not come with an excess risk of major bleeding (RR, 1.31, 95 percent CI, 0.57–3.01; p=0.53), major bleeding (RR, 1.67, 95 percent CI, 0.77–3.63; p=0.20), or blood transfusion (RR, 0.34, 95 percent CI, 0.10–1.15; p=0.08).

“This study expands the evidence supporting CDT as first-line therapy for sPE, and more RCTs are indicated to confirm our findings,” the researchers said.