Outcomes with treatment interventions for clot-in-transit in patients with pulmonary embolism: a meta-analysis.

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Invasive Cardiology Pub Date : 2024-05-21 DOI:10.25270/jic/24.00089

Muhammad Haisum Maqsood, Robert S Zhang, David M Zlotnick, Sahil A Parikh, Sripal Bangalore

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引用次数: 0

Abstract

Objectives: Clot-in-transit (CIT) in patients with pulmonary embolism (PE) has been associated with a high mortality rate and poor prognosis. The aim of this study was to evaluate the pooled efficacy of each of the 4 interventions (anticoagulation [AC] alone, systemic thrombolytic [ST] therapy, surgical thrombectomy, and catheter-based thrombectomy [CBT]) using mortality as the primary outcome.

Methods: A time limited search until March 28, 2024 was conducted using PubMed (National Institutes of Health) and EMBASE (Elsevier) databases.

Results: Thirteen studies (6 retrospective, 4 non-randomized prospective, and 3 pooled studies of case-reports) were included in the calculation of weighted proportion of mortality, including a total of 492 patients with CIT and PE with a mean age of 60.6 years; 50.1% were males. ST was the most frequently used treatment intervention (38.2%), followed by surgical thrombectomy (33.8%), AC alone (22.6%), and CBT (5.9%). The unweighted mortality was highest with AC alone 32.4% (36/111), followed by surgical thrombectomy 23.2% (38/164), CBT 20.7% (6/29), and ST 13.8% (26/188). The weighted mortality for AC alone was 35% (95% CI, 21% to 49%; 12 studies), surgical thrombectomy was 31% (95% CI, 16% to 47%; 12 studies), CBT was 20% (95% CI, 6% to 34%; 3 studies), and ST was 12% (95% CI, 5% to 19%; 12 studies).

Conclusions: In this meta-analysis of patients with CIT and PE, the highest mortality was observed with AC alone, followed by surgical thrombectomy, CBT, and ST therapy. However, there remains a need for randomized clinical trial data to determine the best treatment.

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肺栓塞患者血栓在途治疗干预的结果：一项荟萃分析。

目的：肺栓塞（PE）患者的在途血栓（CIT）与高死亡率和不良预后有关。本研究旨在以死亡率为主要结果，评估 4 种干预措施（单独抗凝[AC]、全身溶栓[ST]疗法、外科血栓切除术和导管血栓切除术[CBT]）各自的综合疗效：方法：使用 PubMed（美国国立卫生研究院）和 EMBASE（爱思唯尔）数据库进行限时检索，直至 2024 年 3 月 28 日：在计算加权死亡率比例时纳入了 13 项研究（6 项回顾性研究、4 项非随机前瞻性研究和 3 项病例报告汇总研究），共包括 492 名 CIT 和 PE 患者，平均年龄为 60.6 岁；50.1% 为男性。ST是最常用的治疗干预措施（38.2%），其次是外科血栓切除术（33.8%）、单纯AC（22.6%）和CBT（5.9%）。单纯 AC 的非加权死亡率最高，为 32.4%（36/111），其次是手术血栓切除术 23.2%（38/164）、CBT 20.7%（6/29）和 ST 13.8%（26/188）。单纯 AC 的加权死亡率为 35% (95% CI, 21% to 49%; 12 项研究)，手术血栓切除术为 31% (95% CI, 16% to 47%; 12 项研究)，CBT 为 20% (95% CI, 6% to 34%; 3 项研究)，ST 为 12% (95% CI, 5% to 19%; 12 项研究)：在这项针对 CIT 和 PE 患者的荟萃分析中，观察到单用 AC 的死亡率最高，其次是手术血栓切除术、CBT 和 ST 治疗。然而，仍需要随机临床试验数据来确定最佳治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Invasive Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.90

自引率

6.70%

发文量

214

审稿时长

3-8 weeks

期刊介绍： The Journal of Invasive Cardiology will consider for publication suitable articles on topics pertaining to the invasive treatment of patients with cardiovascular disease.