ABSTRACT
OBJECTIVE To assess the efficacy and safety of tenecteplase in patients with pulmonary embolism (PE). METHODS We completed the literature search on May 31, 2021 using PubMed, EMBASE and the Web of Science. Analyses were conducted according to PE risk stratification, study design and duration of follow-up. The pooled risk ratios (RRs) and its 95% confident intervals (CIs) for death and major bleeding were calculated using a random-effect model. RESULTS A total of six studies, with four randomized controlled trials (RCTs) and two cohort studies, were included in this study out of the 160 studies retrieved. For patients with high-risk PE, tenecteplase increased 30-day survival rate (16% vs 6%; P=0.005) and did not increase the incidence of bleeding (6% vs 5%; P=0.73). For patients with intermediate-risk PE, four RCTs suggested that tenecteplase reduced right ventricular insufficiency at 24h early in the onset and the incidence of hemodynamic failure without affecting mortality in a short/long-term [<30 days RR=0.83, 95% CI (0.47, 1.46);≥30 days RR=1.04, 95% CI (0.88, 1.22)]. However, tenecteplase was associated with high bleeding risk [<30 days RR=1.79, 95% CI (1.61, 2.00); ≥30 days RR=1.28, 95% CI (0.62, 2.64)]. CONCLUSIONS Tenecteplase may represent a promising candidate for patients with intermediate/high risk PE. Furthermore, tenecteplase may be preferable in the COVID-19 pandemic due to its all-at-once administration.
Subject(s)
Pulmonary Embolism , Renal Insufficiency , COVID-19 , Addison DiseaseABSTRACT
Background: An increased risk of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID-19) has been reported. We performed a meta-analysis to evaluate the prevalence of VTE in COVID-19 patients.Methods: The PubMed and Embase databases were searched for studies reporting VTE in COVID-19 patients up to June 27, 2020. The selected studies were predefined into the “suspected screening group” and the “routine screening group.” The VTE prevalence was calculated using random-effect models.Results: We selected 20 studies including a total of 2763 COVID-19 patients. In 2203 COVID-19 patients from the suspected screening group, the pool VTE incidence was 15.2% (95% confidence interval [CI]: 10.5–21.6%). In 560 COVID-19 patients from the routine screening group, the VTE prevalence was 40.8% (95% CI: 20.6–64.7%). Furthermore, the VTE incidence of critically ill COVID-19 patients from the two groups was 19.6% and 61.4%, respectively, which indicates that critically ill COVID-19 patients were more susceptible to VTE.Conclusions: A high incidence of VTE was observed in COVID-19 patients, especially in severe cases. The incidence of VTE in COVID-19 patients from the routine screening group was higher than that in patients from the suspected screening group. This indicates that a lower threshold of suspicion to perform VTE imaging tests may be reasonable and there is an urgent need to adapt a regular screening strategy for VTE.