ClinicalTen studies with 760 patients show there was a decrease which may be of clinical importance in the group treated with thrombolytic therapy compared with heparin alone for all cause mortality (LOW QUALITY).
In the haemodynamically unstable subgroup, four studies with 224 patients show there was a decrease which may be of clinical importance in the group treated with thrombolytic therapy compared with heparin alone for all cause mortality (VERY LOW QUALITY).
In the haemodynamically stable subgroup, six studies with 536 patients show that it is very uncertain whether there is any difference in all cause mortality between the thrombolytic therapy and heparin alone (VERY LOW QUALITY).
Ten studies with 760 patients show there was a decrease which may be of clinical importance in the group treated with thrombolytic therapy compared with heparin alone for VTE related mortality (LOW QUALITY).
In the haemodynamically unstable subgroup, four studies of 224 patients show that it is very uncertain whether there is a clinically important difference in VTE related mortality between thrombolytic therapy and heparin alone (VERY LOW QUALITY).
In the haemodynamically stable subgroup, six studies with 536 patients show that it is very uncertain whether there is any difference in VTE related mortality between the thrombolytic therapy and heparin alone group (VERY LOW QUALITY).
Nine studies with 752 patients show there was an increase which may be of clinical importance in the group treated with thrombolytic therapy compared with heparin alone for major bleeding (VERY LOW QUALITY).
In the haemodynamically unstable subgroup, three studies with 216 patients show there was an increase which may be of clinical importance in the group treated with thrombolytic therapy compared with heparin alone for major bleeding (VERY LOW QUALITY).
In the haemodynamically stable subgroup, six studies with 536 patients show that it is very uncertain whether there is a clinically important difference in major bleeding between thrombolytic therapy and heparin alone (VERY LOW QUALITY).
VTE recurrence has been identified as an important outcome but the data was unreliably reported in the studies.
No studies reported outcomes for quality of life, chronic thromboembolic pulmonary hypertension, length of hospital stay or heparin induced thrombocytopenia.
EconomicAdditional pharmacological thrombolytic treatment increases costs and generates fewer QALYs compared to anticoagulation treatment alone in haemodynamically stable (systolic blood pressure >90mmHg) patients with right ventricular dysfunction.

From: 9, Thrombolytic therapy for PE

Cover of Venous Thromboembolic Diseases
Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing [Internet].
NICE Clinical Guidelines, No. 144.
National Clinical Guideline Centre (UK).
Copyright © 2012, National Clinical Guideline Centre.

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