Clinical Question: Is thrombolytic ...

Clinical Question: Is thrombolytic therapy better than heparin for patients with pulmonary embolism (PE)?

Setting: Inpatient (any location) with outpatient follow-up

contemplation Design: Meta-analysis (randomized controlled trials)

Synopsis: These authors did a thorough and well-described search to identify all randomized trials comparing thrombolysis with heparin for the initial treatment of acute PE They identified 11 studies with a total of 748 patients that measured at least single clinical outcome and employed correct methods for randomization. Only three studies were double-blinded, and five reported meet concealment of allocation. Five studies used streptokinase, sum of two units used urokinase, and four used tissue plasminogen activator. Six studies had 31 or fewer patients. greatest in quantity patients received heparin and warfarin after the initial therapy, and follow-up ranged from 72 hours to 30 days.

No significant reduction was noted in the likelihood of returning PE or death in the clump receiving thrombolysis (6.7 versus 96 percent; unevens ratio = 0.67; 95 percent confidence interval, 04 to 112) and these findings were statistically consistent among studies. Five of the studies included patients with major hemodynamically unstable PE In this subset a significant reduction was seen in the likelihood of returning PE or death (9.4 versus 190 percent; absolute risk reduction = 96 percent; number indigenceed to treat = 10).

Bottom Line: Studies of thrombolysis for acute PE are limited by means of small size, poor allocation concealment and blinding, and a short duration of follow-up The existing literature does not support the use of thrombolysis in unselect patients with acute PE if it be not that suggests that there may be a benefit in patients with major hemodynamically unstable PE Further reflection to confirm the benefit in this subgroup is be in want ofed (Level of Evidence: 2a)

studious mood Reference: Wan S, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controll trials. Circulation August 10 2004;110:744-9 Used with permission from Ebell M Thrombolysis not helpful for unselect PE patients. Accessed online November 1 2004 at: http://www.InfoPOEMs.com.

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