AUTHOR=Tan Jiang-Shan , Liu Ningning , Hu Song , Wu Yan , Gao Xin , Guo Ting-Ting , Yan Xin-Xin , Peng Fu-Hua , Hua Lu 

TITLE=Association Between the Use of Pre- and Post-thrombolysis Anticoagulation With All-Cause Mortality and Major Bleeding in Patients With Pulmonary Embolism

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.880189

DOI=10.3389/fcvm.2022.880189

ISSN=2297-055X

ABSTRACT=Objective: To explore the comparative clinical efficacy and safety outcomes of anticoagulation before (Pre-) or following (Post-) thrombolytic therapy in systemic thrombolytic therapy for Pulmonary Embolism (PE). 
Methods: PubMed, the Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases were searched from inception through 1st, May, 2021. All randomized clinical trials comparing systemic thrombolytic therapy vs. anticoagulation alone in patients with PE and written in English were eligible. The primary efficacy and safety outcomes were all-cause mortality and major bleeding, respectively. Odds ratios (OR) estimates and associated 95% confidence intervals (CIs) were calculated. A Bayesian network analysis was performed using R studio software, and then the efficacy and safety rankings were derived.
Results: This network meta-analysis enrolled 15 trials randomizing 2076 patients. According to the plot rankings, the anticoagulant therapy was the best in terms of major bleeding, and the post-thrombolysis anticoagulation was the best in terms of all-cause mortality. Taking major bleeding and all-cause mortality into consideration, the most safe-effective treatment was the post-thrombolysis anticoagulation in patients who needed thrombolytic therapy. The net clinical benefit analysis comparing associated ICH benefits vs. mortality risks of post-thrombolysis anticoagulation demonstrated a net clinical benefit of 1.74 %. 
Conclusion：The systemic thrombolysis followed anticoagulation had the better advantage in all-cause mortality and major bleeding than the systemic thrombolysis with before anticoagulation. The adjuvant anticoagulation treatment of systemic thrombolytic therapy should be optimized.