(HealthDay News) — Among patients 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 research published in the June 18 issue of the Journal of the American Medical Association.
Saurav Chatterjee, MD, from the St Luke’s-Roosevelt Hospital Center of the Mount Sinai Health System in New York City, and colleagues conducted a literature review to identify randomized clinical trials comparing thrombolytic therapy vs. anticoagulant therapy in pulmonary embolism patients. Of the 16 trials (2,115 individuals) identified, 8 trials (1,775 patients) included patients with intermediate-risk pulmonary embolism.
The researchers found that use of thrombolytics was associated with lower all-cause mortality (odds ratio [OR], 0.53; 2.17% vs. 3.89% with anticoagulants; number needed to treat [NNT], 59) and greater risks of major bleeding (OR, 2.73; 9.24 vs. 3.42%; number needed to harm [NNH], 18) and ICH (OR, 4.63; 1.46 vs. 0.19%; NNH, 78). In patients ≤65 years, major bleeding was not significantly increased (OR, 1.25; 95% confidence interval, 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.
“Findings may not apply to patients with pulmonary embolism who are hemodynamically stable without right ventricular dysfunction,” the authors write.
Several authors disclosed financial ties to the medical device industry.