HealthDay News — Among patients diagnosed with pulmonary embolism, thrombolytic therapy is associated with lower rates of all-cause mortality but increased risks of major bleeding and intracranial hemorrhage (ICH) compared with anticoagulation therapy, according to researchers.
“To date, no analysis has had adequate statistical power to determine whether thrombolytic therapy is associated with improved survival, compared with conventional anticoagulation,” wrote Saurav Chatterjee, MD, of St. Luke’s-Roosevelt Hospital Center in New York City, and colleagues. Their findings were published in the Journal of the American Medical Association.
After conducting a literature review identifying randomized clinical trials comparing thrombolytic therapy with anticoagulant therapy in pulmonary embolism patients, the investigators found that of the 16 trials (n=2,115 patients) identified, eight included patients (n=1,775) with intermediate-risk pulmonary embolism.
The use of thrombolytics was associated with lower all-cause mortality (odds ratio, 0.53; 2.17% versus 3.89% with anticoagulants; number needed to treat, 59) and greater risks of major bleeding (OR, 2.73; 9.24% versus 3.42%; number needed to harm,18) and ICH (OR, 4.63; 1.46% versus 0.19%; NNH, 78).
In patients up to age 65 years, major bleeding was not significantly increased (OR, 1.25; 95% CI: 0.50- 3.14). There was a lower risk of recurrent pulmonary embolism associated with thrombolysis (OR, 0.40; NNT, 54). Thrombolysis was associated with lower mortality (OR, 0.48) and more major bleeding events (OR, 3.19) in intermediate-risk pulmonary embolism trials.
“Among patients with pulmonary embolism, including those who were hemodynamically stable with right ventricular dysfunction, thrombolytic therapy was associated with lower rates of all-cause mortality and increased risks of major bleeding and ICH,” wrote the researchers.