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Efficacy of thrombolytic agents in the treatment of pulmonary embolism

Depts of ¹ Pharmacy, and ² Respiratory Medicine, Leeds General Infirmary, Leeds, UK.

CORRESPONDENCE: M. Henry, Dept of Respiratory Medicine, Leeds General Infirmary, Great George St., Leeds LS1 3EX, UK. Fax: 44 1133926316. E-mail: michael.henry{at}leedsth.nhs.uk

Keywords: Fibrinolysis, pulmonary embolism, streptokinase, thrombolysis, tissue plasminogen activator

Received: January 9, 2005
Accepted July 13, 2005

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 both bolus-dose alteplase and streptokinase (RR: 0.16; 95% CI: 0.05–0.59 and RR: 0.13; 95% CI: 0.04–0.46, respectively).

In conclusion, this evidence suggests that the three thrombolytic agents may vary in efficacy. However, large-scale randomised controlled trials are needed to confirm these results.

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