A meta-analysis of catheter-directed thrombolysis versus standard anticoagulation among patients with intermediate high risk pulmonary embolism

Abstract Background Pulmonary embolism (PE) is a life-threatening condition requiring prompt treatment, especially in intermediate-high-risk cases. There are limited studies and randomized controlled trials (RCTs) comparing catheter-directed thrombolysis (CDT) and standard anticoagulation (SA) in treating pulmonary embolism (PE). Hence, a meta-analysis is imperative. Methods A literature search from Pubmed, Embase, and Cochrane databases for relevant RCTs and observational studies published until December 2022 were conducted. The pooled estimates of all-cause mortality and major bleeding events were measured using RStudio software latest version. Results This is a meta-analysis of nine (9) studies, with a total population of 1,822 patients; 909 patients represented the CDT group, while 913 patients for SA group. The mean age of participants ranged widely, from 51 to 72 years in the CDT groups and 56 to 64 years in the SA groups, reflecting diverse patient populations. Based on the collective evidence, the overall effect size, represented by an risk ratio (RR) of 0.48, indicated a 52% reduction in the risk of all-cause mortality with catheter-directed thrombolysis (CDT) (p-value < 0.01). However, a risk ratio (RR) of 2.23, indicated a 2.23 times higher risk of major bleeding with catheter-directed thrombolysis (CDT) compared to standard anticoagulants (SA). Conclusion This meta-analysis revealed that catheter-directed thrombolysis (CDT) significantly reduced all-cause mortality compared to standard anticoagulants (SA). However, CDT was associated with a 2.47 times higher risk of major bleeding, highlighting the importance of evaluating its safety profile in this patient population. CDT may be a valuable therapeutic option for selected patients, but further robust evidence is needed to refine patient selection criteria and optimize treatment strategies to balance efficacy and safety.