This meta-analysis compared mechanical thrombectomy plus anticoagulation with anticoagulation alone in adults with intermediate- to high-risk acute pulmonary embolism. Seven studies included 9,371 participants: two randomized trials and five cohorts. Thrombectomy was associated with lower 30-day mortality (OR 0.28; 95% CI 0.17–0.47) and greater RV/LV ratio improvement (mean difference −0.25; 95% CI −0.36 to −0.13). Neither bleeding (OR 0.82; 95% CI 0.57–1.18) nor PE-related mortality (OR 1.25; 95% CI 0.22–7.28) differed significantly. ICU and hospital stays were not significantly reduced, with substantial between-study variability.
The pooled evidence links thrombectomy to lower early mortality, but does not establish a causal survival benefit. Effects on PE-specific mortality and resource use remain uncertain.
Study limitation: Five of seven studies were observational, limiting causal interpretation; the wide PE-related mortality confidence interval leaves substantial uncertainty.
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