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ORIGINAL ARTICLE

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

Prakash Raj Oli1 ,  Dhan Bahadur Shrestha2* ,  Sagun Dawadi3 ,  Jurgen Shtembari4 ,  Jishanth Mattumpuram5 ,  Daniel H. Katz2
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1 Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois, United States of America
2 Division of Cardiology, Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, United States of America
3 Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati, Nepal
4 Division of Cardiology, Department of Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, United States of America
5 Division of Cardiology, Department of Internal Medicine, University of Louisville, Louisville, Kentucky, United States of America
JCTR, 025340056 https://doi.org/10.36922/JCTR025340056
© Invalid date by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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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
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Journal of Clinical and Translational Research, Electronic ISSN: 2424-810X Print ISSN: 2382-6533, Published by AccScience Publishing
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