This meta-analysis included six randomized trials involving 886 patients with acute intermediate-risk pulmonary embolism. Compared with anticoagulation alone, adding catheter-directed thrombolysis reduced the RV/LV ratio (mean difference −0.11, 95% CI −0.21 to −0.00) and early cardiorespiratory deterioration (risk ratio 0.36, 95% CI 0.19–0.68). Mortality did not differ between groups. Major bleeding was not significantly different, but its estimate remained imprecise (risk ratio 1.52, 95% CI 0.71–3.24). Any bleeding and vascular access-site complications or hematomas were significantly more frequent with catheter-directed thrombolysis, highlighting a trade-off between early improvement and procedural harms.
The pooled trials suggest less early deterioration with catheter-directed thrombolysis, but no mortality difference was demonstrated. Increased bleeding and access-site complications temper the early efficacy findings.
Study limitation: The major-bleeding confidence interval permits substantial harm; larger trials with longer follow-up are needed to clarify sustained clinical outcomes.
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