Authors' objectives:

After three decades since the introduction of thrombolytic agents, its application in the treatment of pulmonary thromboembolism (PTE) is still a controversial topic. The objective of this paper is to assess the efficacy and the safety of the thrombolytic agents in the treatment of PTE by means of a meta-analytic study of the randomized clinical trials published that have this objective.

Authors' results and conclusions: The analysed studies are very heterogeneous, regarding both the type of thrombolytic therapy used, and its schedule and the outcome measures used. Of the 8 studies assessed, 6 show that, according to angiographic and gammagraphic variables, the thrombolytic agents speed up the resolution of the thrombus. However, 24-72 hours after starting the therapy, there are no differences in this outcome among the patients who have received thrombolytic therapy and the ones who have received the usual therapy with heparin. The results of the meta-analysis have not found differences in the mortality rate nor in the recurrence rates of PTE at short term among the patients treated with thrombolytics and those not treated. On the other hand, the meta-analysis shows that the patients with PTE treated with thrombolytic agents show a higher risk of bleeding than those who have not received this therapy. However, it should be noted that most of these bleeding are related to the insertion of catheters into the patient.

Authors' recommendations: The efficacy of the thrombolytic agents in decreasing mortality and/or the relapses in the acute phase of PTE has not been proven yet. In contrast, the patients treated with these drugs have a significantly higher risk of bleeding compared to the patients who have not received this type of therapy. We do not recommend the routine use of thrombolytic agents in the treatment of pulmonary embolism in every day clinical practice since risks seem to be greater than benefits. Nevertheless, these agents might be used in the context of a high-quality, well-design randomized clinical trial that assesses the efficacy of such drugs in the subgroup of more severe patients who presumably can benefit most from it.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 1997

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research