阿替普酶初始溶栓序贯抗凝治疗老年急性次大面积肺栓塞疗效与安全性的meta分析

目的:系统评价阿替普酶初始溶栓序贯抗凝治疗老年急性次大面积肺栓塞(ASPE)的疗效与安全性。方法:检索中国知网、维普数据、中国生物医学文献数据库、万方数据、Medline、Embase、PubMed、The Cochrane Library、Clinical Trials，收集阿替普酶溶栓序贯抗凝对比单纯抗凝治疗ASP...

Efficacy and safety of initial thrombolysis with alteplase and sequential anticoagulation in treatment of acute submassive pulmonary embolism in the elderly: a meta-analysis

Objective To systematically evaluate the efficacy and safety of initial thrombolysis with alteplase and sequential anticoagulation in the treatment of acute submassive pulmonary embolism(ASPE)in the elderly.Methods All randomized controlled trials on alteplase thrombolytic sequential anticoagulation versus anticoagulation for ASPE were collected from China National Knowledge Infrastructure,Chongqing VIP database,Chinese Biology Medicine database,Wanfang database,Medline,Embase,PubMed,The Cochrane Library,and Clinical Trials.Two reviewers screened the literatures from the database construction to February 2020,extracted data,and assessed the methodological quality of included studies.And then meta-analysis was conducted using Review Manager 5.3 software.Results Twenty-one studies were included,with a total sample size of 1602 patients.Compared with the anticoagulation,alteplase thrombolytic sequential anticoagulation showed a better efficacy(OR=5.87,95%CI:3.82-9.01,P<0.00001),lower recurrence rate of pulmonary embolism(OR=0.36,95%CI:0.16-0.80,P=0.01)and mortality(OR=0.46,95%CI:0.24-0.86,P=0.02),increased bleeding risk(OR=1.65,95%CI:1.21-2.24,P=0.001).There was no statistical difference in the intracranial hemorrhage between two treatments(OR=0.77,95%CI:0.21-2.77,P=0.69).The subgroup analysis showed that the recurrence rate after sequential anticoagulant therapy with alteplase was lower in the European and American population(OR=0.34,95%CI:0.14-0.83,P=0.02),but there was no statistical difference in the Asian patients.There was no statistical difference in the mortality rate and fatal bleeding rate in the Asian and European patients.Conclusions The initial thrombolysis with alteplase and sequence anticoagulation can reduce the mortality and recurrence rate of elderly ASPE patients.Although thrombolytic therapy can increase the risk of bleeding,the medium and long-term efficacy is still superior to anticoagulation.