SynthesisJournal of thrombosis and thrombolysis2020
Thrombolysis in massive and submassive pulmonary embolism during pregnancy and the puerperium: a systematic review.
Synthesis in Journal of thrombosis and thrombolysis, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
What it found
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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.
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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.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Endovascular reperfusion strategies for pregnancy-related pulmonary embolism: a systematic review.Journal of thrombosis and thrombolysis · 2026Pooled it
- Clinical outcomes of very elderly patients treated with ultrasound-assisted catheter-directed thrombolysis for pulmonary embolism: a systematic review.Journal of thrombosis and thrombolysis · 2021Pooled it
- Regulation of histones in thromboinflammation.Frontiers in immunology · 2026Review
- Clinical approach to respiratory failure in the obstetric patient: a comprehensive clinical review.Proceedings (Baylor University. Medical Center) · 2025Review
- Pregnancy-Related Thromboembolism-Current Challenges at the Emergency Department.Journal of personalized medicine · 2024Review
- Pulmonary Embolism in Pregnancy: A Review for Clinical Practitioners.Journal of clinical medicine · 2024Review
- Successful Treatment of Massive Pulmonary Embolism in Pregnancy with Catheter-Directed Embolectomy.AJP reports · 2024Article
- High-Risk Pulmonary Embolism During Labor:JACC. Case reports · 2023Review
- Pulmonary Thromboembolism in Pregnancy: A Case Report and Literature Review.Open access emergency medicine : OAEM · 2023Article
- Editorial: Pulmonary embolism-New diagnostic and therapeutic strategies.Frontiers in medicine · 2023Article
- Obstetric Disorders and Critical Illness.Clinics in chest medicine · 2022Review
- Acute Coronary Syndrome in Pregnancy and the Post-Partum Period.Journal of cardiovascular development and disease · 2022Review
- Pulmonary thromboembolism and its complications in a patient in labour.BMJ case reports · 2022Article
- Inter-Specialty Controversies on the Treatment of Cardiovascular Diseases during Pregnancy: A Questionnaire Study.Medicina (Kaunas, Lithuania) · 2022Article
- Pregnancy-Associated Venous Thromboembolism: Insights from GARFIELD-VTE.TH open : companion journal to thrombosis and haemostasis · 2021Article
- Systemic Thrombolysis for Treatment of Postpartum Saddle Embolism Complicated by Postpartum Hemorrhage: A Case Report and Brief Literature Review.Case reports in obstetrics and gynecology · 2021Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Thrombolysis in high-risk pulmonary embolism (PE) patients is recommended worldwide; however, the evidence for thrombolysis during pregnancy and the immediate puerperium remains unclear. We conducted a systematic review from 1950 to 2019 through PubMed, Ovid/Willey, and Cochrane Library to assess the safety and effectiveness of thrombolysis during pregnancy and the immediate puerperium. Additionally, we characterized the clinical presentation, risk stratification, and diagnostic approach. We have communicated our results according to the PRISMA statement. We collected 141 records and, after critical assessment, included 47 case reports of 54 patients, including 43 and 11 patients during pregnancy and puerperium, respectively. During pregnancy, alteplase was the most frequent systemic thrombolytic agent used (67%), but only nine patients received the approved FDA regimen. With catheter-directed thrombolysis, low-dose thrombolytics and fragmentation were the most common regimens. Major bleeding occurred in 18% of cases, but there was no intracranial bleeding. One maternal death occurred secondary to refractory cardiogenic shock. Fetal mortality was 20%. During the immediate puerperium, nine patients received "off-label" first-, second-, and third-generation thrombolytic regimens, and four cases underwent catheter-directed thrombolysis. We observed nine major bleeding events, seven of which were from the uterine location and none of which were intracranial. In conclusion, overall, these data do not suggest prohibitive risk associated with thrombolysis for PE in pregnancy. Management of massive and high-risk submassive PE in pregnancy should be individualized to each patient. In the data presented, no fatal bleeding or intracranial bleeding was observed. Finally, future efforts should systematically collect and report data on high-risk PE in pregnancy and peripartum patients to improve the evidence-base clinical practice.
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Registered trials
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