P1613Efficacy and safety outcomes of recanalization procedures in patients with acute symptomatic pulmonary embolism: systematic review and network meta-analysis

Abstract

Background: We aimed to review the efficacy and safety of the recanalization procedures for the treatment of pulmonary embolism (PE). Method(s): We searched PubMed, the Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from inception through July 31, 2015, and included randomized clinical trials that compared the effect of a recanalization procedure vs. each other or anticoagulant therapy in patients diagnosed with PE. We used network meta-analysis and multivariate random-effects meta-regression to estimate pooled differences between each intervention, and meta-regression to assess the association between trial characteristics and the reported effects of recanalization procedures vs. anticoagulation. Result(s): For all-cause mortality, there were no significant differences in events rates between any of the recanalization procedures and anticoagulant treatment (full-dose thrombolysis: odds ratio, 0.60; low-dose thrombolysis: 0.47; and catheter-associated thrombolysis: 0.31). Full-dose thrombolysis increased the risk of major bleeding (2.00) compared with anticoagulation. Catheter-directed thrombolysis was associated with the lowest probability of dying (surface under the cumulative ranking curve [SUCRA], 0.67), followed by low-dose thrombolysis (SUCRA, 0.66), and full-dose thrombolysis (SUCRA, 0.55). Similarly, low-dose thrombolysis was associated with the lowest probability of major bleeding (SUCRA, 0.61), followed by catheter-directed thrombolysis (SUCRA, 0.54), and fulldose thrombolysis (SUCRA, 0.17). The results were similar in sensitivity analyses based on restricting only to studies in hemodynamically stable PE patients. Conclusion(s): In the treatment of PE, recanalization procedures do not seem to offer a clear advantage compared with standard anticoagulation. Low-dose thrombolysis might be the best option to consider when a recanalization procedure is indicated.