Health Service Executive

Efficacy of thrombolytic agents in the treatment of pulmonary embolism T. Capstick * and M.T. Henry# ABSTRACT: Recent guidelines recommend bolus-dose alteplase for treating massive pulmonary embolism (PE). However, the safest and most effective treatment is as yet unknown. In the present study, a meta-analysis of published studies of alteplase infusion, bolus-dose alteplase and streptokinase was performed. The outcome measures were as follows: objective assessment of thrombolysis; all-cause mortality; deaths due to initial PE, major bleeding episodes and recurrent PE; and morbidity. In total, 26 studies were identified; however, only two comparative studies of alteplase infusion versus either bolus-dose alteplase or streptokinase were found. Meta-analysis revealed no significant difference between the three regimens, but was compromised by a paucity of data. Crude analysis of summated data on thrombolytic efficacy from all studies revealed that alteplase infusion was more effective than bolus-dose alteplase (relative risk (RR): 1.95; 95 % confidence interval (CI): 1.19–3.2), whereas streptokinase was more effective than alteplase infusion (RR: 1.27; 95 % CI: 1.09–1.47). Alteplase infusion had a lower mortality due to the initial PE than bot