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

Methodology Score:    4.5/5                
Usefulness Score:  3/5

Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, Kumbhani DJ, Mukherjee D, Jaff MR, Giri J.
JAMA. 2014 Jun 18;311(23):2414-21.

This methodologically-sound meta-analysis found that among patients presenting with both massive and sub-massive pulmonary embolism, thrombolysis was associated with decreased risk of all cause mortality compared with anticoagulation (OR, 0.53; 95% CI, 0.32-0.88; NNT = 59) and an increased risk of major bleeding (OR, 2.73; 95% CI, 1.91-3.9; NNH = 18).  The group felt the in sub-massive PE, the mortality benefit of thrombolysis most clearly outweighed the risk of bleeding in patients under the age of 65 (NNT = 51, P = 0.09 vs. NNH = 176, P = 0.89) and, in consultation with thrombosis, we would consider thrombolysis for this patient population.
By: Dr. Magdalena Kisilewicz
(Presented Sept 2014)

Epi lesson: Cochrane Collaboration Tool for Assessing Risk of Bias in Intervention Trials

The use of scales for assessing quality or risk of bias in intervention trials is explicitly discouraged in Cochrane reviews, including the commonly-used scale was developed by Jadad and colleagues for randomized trials in pain research (Jadad 1996). For assessing bias, the Cochrane Collaboration recommends a two-part tool that addresses seven specific domains (sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective outcome reporting and ‘other issues’).  Each domain in the tool includes one or more specific entries in a ‘Risk of bias’ table. 
By: Dr. Ian Stiell


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