Evidence map›Paper›PMID 24917641›Full record

SynthesisEuropean heart journal2015

Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis.

Christophe Marti, Gregor John, Stavros Konstantinides, Christophe Combescure, Olivier Sanchez, Mareike Lankeit, Guy Meyer, Arnaud Perrier

4 registry-linked trialsOpen access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 227 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
227citing papers in PubMed, 15 pooled it
23.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03988842 phase4terminatednot on this mapstarted 2019, after this paper: background citation

Standard-dose Apixaban AFtEr Very Low-dose ThromboLYSis for Acute Intermediate-high Risk Acute Pulmonary Embolism

TypeinterventionalSponsorVictor Tapson, MDRan2019 to 2020Enrolled4ConditionsPulmonary Embolism With Acute Cor Pulmonale, Pulmonary Embolism, Pulmonary Embolism With Pulmonary Infarction, Pulmonary Embolism Subacute MassiveArmsAlteplase, Unfractionated heparin, Placebo, Apixaban
NCT04430569 phase3active not recruitingnot on this mapstarted 2021, after this paper: background citation

A Reduced Dose of Thrombolytic Treatment for Patients With Intermediate High-risk Acute Pulmonary Embolism: a Randomized Controled Trial

TypeinterventionalSponsorAssistance Publique - Hôpitaux de ParisRan2021 to 2028Enrolled800ConditionsPulmonary EmbolismArmsAlteplase, Placebo
NCT04790370 phase4active not recruitingnot on this mapstarted 2021, after this paper: background citation

A Randomized Trial of Ultrasound-facilitated, Catheter-directed, Thrombolysis Versus Anticoagulation for Acute Intermediate-high Risk Pulmonary Embolism: The Higher-risk Pulmonary Embolism Thrombolysis Study

TypeinterventionalSponsorBoston Scientific CorporationRan2021 to 2026Enrolled544ConditionsPulmonary EmbolismArmsAnticoagulation with heparin, EkoSonicTM Endovascular System
NCT04855370 nawithdrawnnot on this mapstarted 2025, after this paper: background citation

Use of Non-invasive Measurement of Cardiac Output and Stroke Volume to Assess Risk and Response to Treatment in Patients With Pulmonary Embolism (PE)

TypeinterventionalSponsorUniversity of California, Los AngelesRan2025 to 2025Enrolled0ConditionsPulmonary Embolism, Pulmonary Embolus/Emboli, Pulmonary Disease, Pulmonary Embolism and ThrombosisArmsNon-invasive hemodynamic measurements
3 · Its place in the literature

Who cites it

227 citing papers in PubMed, 15 syntheses or guidelines pooled it, 574 citations in OpenAlex.

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  11. Thrombolytic therapy for pulmonary embolism.The Cochrane database of systematic reviews · 2021
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  12. Guideline
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  14. Thrombolytic therapy for pulmonary embolism.The Cochrane database of systematic reviews · 2018
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  20. The Efficacy and Safety of Intermittent Low-Dose Urokinase Thrombolysis for the Treatment of Senile Acute Intermediate-High-Risk Pulmonary Embolism: A Pilot Trial.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis · 2018
    Trial

167 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 3 countries.

Christophe MartiDepartment of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland christophe.marti@hcuge.ch.
Gregor JohnDepartment of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland.
Stavros KonstantinidesCenter for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
Christophe CombescureDepartment of Health and Community Medicine, University Hospitals of Geneva and Geneva Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland.
Olivier SanchezHôpital Européen Georges Pompidou, AP-HP; Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S 970, Paris; GIRC Thrombose, France.
Mareike LankeitCenter for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
Guy MeyerHôpital Européen Georges Pompidou, AP-HP; Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S 970, Paris; GIRC Thrombose, France.
Arnaud PerrierDepartment of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland.
University Hospital of Geneva · CHUniversity Medical Center of the Johannes Gutenberg University Mainz · DEDélégation Paris 5 · FRHôpital Européen · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimThrombolytic therapy induces faster clot dissolution than anticoagulation in patients with acute pulmonary embolism (PE) but is associated with an increased risk of haemorrhage. We reviewed the risks and benefits of thrombolytic therapy in the management of patients with acute PE. METHODS AND

resultsWe systematically reviewed randomized controlled studies comparing systemic thrombolytic therapy plus anticoagulation with anticoagulation alone in patients with acute PE. Fifteen trials involving 2057 patients were included in our meta-analysis. Compared with heparin, thrombolytic therapy was associated with a significant reduction of overall mortality (OR; 0.59, 95% CI: 0.36-0.96). This reduction was not statistically significant after exclusion of studies including high-risk PE (OR; 0.64, 95% CI: 0.35-1.17). Thrombolytic therapy was associated with a significant reduction in the combined endpoint of death or treatment escalation (OR: 0.34, 95% CI: 0.22-0.53), PE-related mortality (OR: 0.29; 95% CI: 0.14-0.60) and PE recurrence (OR: 0.50; 95% CI: 0.27-0.94). Major haemorrhage (OR; 2.91, 95% CI: 1.95-4.36) and fatal or intracranial bleeding (OR: 3.18, 95% CI: 1.25-8.11) were significantly more frequent among patients receiving thrombolysis.

conclusionsThrombolytic therapy reduces total mortality, PE recurrence, and PE-related mortality in patients with acute PE. The decrease in overall mortality is, however, not significant in haemodynamically stable patients with acute PE. Thrombolytic therapy is associated with an increase of major and fatal or intracranial haemorrhage.

Indexed as

Acute DiseaseAnticoagulantsFibrinolytic AgentsHemorrhageHumansPublication BiasPulmonary EmbolismRandomized Controlled Trials as TopicRecurrenceThrombolytic TherapyTreatment OutcomeAnticoagulantsFibrinolytic AgentsPulmonary embolismSystematic reviewThrombolytic therapy

Identifiers

PMID24917641
PMCPMC4352209
OpenAlexW2110112924

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.