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Chatterjee: Thrombolysis for Pulmonary Embolism and Risk of All-Cause Mortality, Major Bleeding, and Intracranial Hemorrhage - A Meta-analysis

Chatterjee. 2014 JAMA:311(23);2414-2421. Clinical QuestionIn patients with PE, does the addition of thrombolysis to anticoagulation, compared with anticoagulation alone, affect mortality and bleeding complications?DesignMeta-analysisFollowed PRISMA statementSystematic search using MeSH and keywords in the following databases:PubMed, Cochrane, EMBASE, EBSCO, Web of Science, CINAHLNo language restrictionPopulationTrial
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TOPCOAT: Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter, double-blind, placebo controlled, randomized trial

Kline, 2014. Journal of Thrombosis and Haemostasis, 12:459-468Clinical QuestionIn patients with submassive PE, does the use of tenecteplase + heparin, compared to heparin alone, improve patient orientated outcomes?DesignRandomised controlled trialDouble-blindedPlacebo-controlledSetting8 centres in the USAAugust 2008 - October 2012PopulationInclusion: adult patients with submassive PEPE diagnosed on
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PEITHO: Fibrinolysis for Patients with Intermediate Risk PulmonaryEmbolism

Meyer, NEJM, 2014;370;1402-11Clinical QuestionIn patients with intermediate-risk/sub-massive pulmonary embolism (PE), does the addition of tenecteplase, compared with heparin alone improve the composite outcome of death and haemodynamic decompensation?DesignRandomised controlled trial, stratified by centreDouble-blindedSetting76 sites in 13 countriesNovember 2007 - July 2012PopulationInclusion criteria:
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MOPETT: Moderate pulmonary embolism treated with thrombolysis

Sharifi. American Journal of Cardiology: 2013; 111(2)273-277.Clinical QuestionIn patients with moderate Pulmonary Embolism (PE), does low dose thrombolysis + anticoagulation, compared with anticoagulation alone, reduce pulmonary artery pressure at 28 months? DesignRandomised controlled trialPatients and clinicians non-blindedBlinding of cardiologists who determined result of primary outcomePowered
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MAPPETT 3: Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism

Konstantinides. NEJM 2002:347(15);1143-1150.Clinical QuestionIn patients with sub-massive PE, does the use of thrombolysis + heparin, compared to heparin alone, reduce the composite outcome of mortality or clinical deterioration? DesignRandomised, double blind, placebo-controlled trialPowered at 80% to detect 13% absolute reduction from baseline incidence of 39%, with alpha level of 5%, if
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