Document Detail


Short term effect of recombinant tissue plasminogen activator in patients with hemodynamically stable acute pulmonary embolism: results of a meta-analysis involving 464 patients.
MedLine Citation:
PMID:  19493561     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
By considering studies where a mixing of patients with and without shock, with or without invasive procedure, treated with various thrombolytic agents through different ways of infusion, have been included, current meta-analyses on thrombolysis efficacy in Pulmonary embolism (PE) are of limited value. Modern management of PE includes the use of both non-invasive diagnostic methods and intravenous rt-PA as thrombolytic agent. METHODS: We performed a meta-analysis of all randomized trials comparing rt-PA with heparin in patients with hemodynamically stable pulmonary embolism. Only the events clearly identified as related with the venous thromboembolic disease or with the treatment were considered. RESULTS: Five studies involving 464 patients were included. The pooled estimate from all the trials revealed a non-statistically significant reduction in death related to PE or pulmonary recurrence for rt-PA compared with heparin (3.5% versus 4.6%; RR 0.97, 95% CI 0.38 to 2.51, P for heterogeneity among the studies=0.73). Compared with heparin, rt-PA was not associated with a significant increase in major bleeding (4.9% versus 4.6%; RR 0.94, 95% CI 0.39 to 2.27). Similar results were found when only studies including patients with echocardiographic evidence of right ventricular dysfunction were considered. CONCLUSION: Neither mortality due to pulmonary embolism nor objective pulmonary embolism recurrence are decreased by rt-PA compared with heparin in patients with hemodynamically stable pulmonary embolism. No benefit is suggested in studies including patients with right ventricular dysfunction alone.
Authors:
B Tardy; C Venet; F Zeni; M Coudrot; S Guyomarc'h; P Mismetti
Publication Detail:
Type:  Journal Article; Meta-Analysis     Date:  2009-06-02
Journal Detail:
Title:  Thrombosis research     Volume:  124     ISSN:  1879-2472     ISO Abbreviation:  Thromb. Res.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2010-02-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0326377     Medline TA:  Thromb Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  672-7     Citation Subset:  IM    
Affiliation:
Intensive Care Unit, CHU, Saint Etienne, 42055, France. bernardtardy@yahoo.fr
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Biological Markers
Databases, Factual
Hemodynamics
Humans
Pulmonary Embolism / drug therapy*
Randomized Controlled Trials as Topic
Recombinant Proteins / therapeutic use*
Thrombolytic Therapy / methods
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Recombinant Proteins
Comments/Corrections
Comment In:
Thromb Res. 2009 Dec;124(6):647-8   [PMID:  19664803 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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