Catheter-directed treatment for acute pulmonary embolism: Systematic review and single-arm meta-analyses

Systemic Thrombolysis, Catheter‐Directed Thrombolysis, and Anticoagulation for Intermediate‐risk Pulmonary Embolism: A Simulation Modeling Analysis

“…In our base case, we assumed a bleeding rate of CDT based on a published meta‐analysis by Bajaj et al . When we based the bleeding rate associated with CDT on published data from the Pulmonary Embolism Response Team (PERT) at Massachusetts General Hospital (MGH), where the bleeding rate for CDT was equal to that of anticoagulation alone, the total QALYs lived after age 65 increased to 7.40 for patients in the CDT treatment arm (compared to 7.35 for patients receiving anticoagulation alone).…”

“…Follow‐up analyses have also examined 2‐year functional status . For the CDT strategy analyzed in the base case, we assigned a major bleeding rate based on results of a recent meta‐analysis . We assumed a linear correlation between major bleeding rates and the rate of a hemorrhagic stroke and used this relationship to derive a probability of hemorrhagic stroke in the initial month of treatment with CDT.…”

Meta-analyses: How to critically appraise them?

“…However, when Golwala et al 4 pooled results from five other studies, a statistically significant treatment effect was observed in favor of ICDs. 4 (3) Generate and test new hypothesis; in a recent meta-analysis by Bajaj et al, 6 the authors investigated reasons for differences in the rates of mortality in patients with acute pulmonary embolism undergoing catheter-based treatment. A meta-regression analysis conducted by the authors showed that higher intrapulmonary thrombolytic usage in part explained the differences in rates of mortality across studies, prompting the need to assess this hypothesis in future studies.…”

“…A meta-regression analysis conducted by the authors showed that higher intrapulmonary thrombolytic usage in part explained the differences in rates of mortality across studies, prompting the need to assess this hypothesis in future studies. 6 (4) Help with design and sample size calculations for future studies; while trying to explain heterogeneity observed across studies, authors can usually attribute it to differences in eligibility criteria, definitions of endpoints, and baseline characteristics across studies. A close investigation of these differences may guide future study design.…”

Catheter-directed thrombolysis for acute pulmonary embolism: Where do we stand?

“…[45] The results of a recent meta-analysis of 35 interventional and observational (“real world”) studies on CDT calculated a pooled rate of 6.6% for major bleeding. [13] If one considers fatal and intracerebral bleeding events only, none of such devastating events occurred in the interventional ULTIMA and SEATTLE II studies,[456] while data from meta-analyses suggested event rates of approximately 2.8% in patients undergoing CDT. [13] Taken together, these data underline the fact that CDT should be performed only in experienced and qualified centers with high volumes of patients.…”