Comparative analysis of safety and efficacy of different advanced therapeutic strategies for acute pulmonary embolism: A Bayesian network meta-analysis

Abstract

Background: Pulmonary embolism (PE) is a major global health concern and the third leading cause of cardiovascular mortality in the U.S. There are various treatment options available for the treatment of intermediate-to-high risk acute PE, including catheter-based treatments, surgical embolectomy, and systemic thrombolysis. Objective: To perform a systematic review and Bayesian network meta-analysis (NMA) comparing the safety and efficacy of advanced therapies in patients with intermediate-to-high risk acute PE. Methods: We searched PubMed/Medline, Embase, and Scopus for relevant studies published until August 30, 2024, and performed a Bayesian NMA to synthesize direct and indirect evidence using the Bayesian inference Using Gibbs Sampling to conduct a Network meta-analysis package in R. Results: Of 1,586 studies, 47 met the inclusion criteria, of which 45 were non-randomized. A total of 267,695 acute intermediate-to-high risk PE patients were included in the analysis, receiving one of five advanced interventions: ultrasound-assisted thrombolysis (USAT), standard catheter-directed thrombolysis (sCDT), catheter-based embolectomy, surgical pulmonary embolectomy (SE), or systemic thrombolysis. USAT had the lowest risk of short-term (94.11), long-term mortality (94.67), major bleeding (90.38), and risk of blood transfusions (91); sCDT had the lowest risk of intracranial hemorrhage (86.2), and SE had the lowest risk of any bleeding (99.37) and gastrointestinal bleeding (87.46) based on Surface Under the Cumulative Ranking values. Conclusion: In our study, USAT offers significant short- and long-term mortality benefits with the lowest risk of major bleeding and transfusion requirements, while sCDT is ideal for patients at high-risk for intracranial hemorrhage. Relevance for patients: Among catheter-based therapies for acute intermediate-to-high-risk PE, USAT offered the best clinical and safety outcomes.

Keywords

Pulmonary embolism / Ultrasound-assisted thrombolysis / Standard catheter-directed thrombolysis / Catheter-based embolectomy / Surgical pulmonary embolectomy / Systemic thrombolysis

Acknowledgments

None.

Funding

None.

Conflict of interest

The authors declare that they have no competing interests.

Author contributions

Conceptualization: Prakash Raj Oli, Dhan Bahadur Shrestha, Sagun Dawadi, Jurgen Shtembari Formal analysis: Prakash Raj Oli Methodology: Prakash Raj Oli, Dhan Bahadur Shrestha, Sagun Dawadi Writing–original draft: Prakash Raj Oli, Dhan Bahadur Shrestha, Sagun Dawadi Writing–review & editing: All authors

Ethics approval and consent to participate

This is a meta-analysis; therefore, it did not require an ethical review committee approval.

Consent for publication

Not applicable.

Availability of data

All data related to the study are presented in the study and supplementary files.

Further disclosure

We would like to disclose that the abstract of this manuscript was presented as a poster at American Heart Association (AHA), Scientific Sessions 2024, Chicago, IL, USA, November 16-18, 2024.

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