{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T06:27:02Z","timestamp":1786602422916,"version":"build-2736575974"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically evaluate the efficacy and safety of low-dose thrombolysis in patients with intermediate-risk pulmonary embolism (PE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was conducted in PubMed, Embase, and the Cochrane Library up to December 6, 2025. Randomized controlled trials (RCTs), non-randomized controlled studies, and cohort studies investigating low-dose thrombolysis for intermediate-risk PE were included. Two researchers independently screened the literature, extracted data, and assessed study quality. A meta-analysis was performed using Stata software (version 16.0) to calculate pooled estimates of mortality, bleeding incidence, and recurrence rates. The efficacy and safety of low-dose thrombolysis were compared with those of anticoagulation alone or full-dose thrombolysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This meta-analysis included 13 studies (1,018 patients with intermediate-risk PE). Low-dose thrombolysis yielded a 1-month and 1-year mortality of 2% (95% CI: 0.00\u20130.03; 0.00\u20130.05), recurrence of 1% (95% CI: 0.00\u20130.02), major bleeding of 1% (95% CI: 0.00\u20130.03), and minor bleeding of 7% (95% CI: 0.05\u20130.10). Subgroup analysis showed ultrasound-assisted catheter-directed thrombolysis (USAT) had 1-month and 1-year mortality rates of 2% (95% CI: 0.01\u20130.04) and 1% (95% CI: 0.00\u20130.03), respectively, vs. 1% (95% CI: 0.00\u20130.03) and 7% (95% CI: 0.01\u20130.16) for low-dose systemic thrombolysis. Compared to anticoagulation alone or full-dose thrombolysis, low-dose systemic thrombolysis showed no significant differences in mortality or recurrence, but had lower bleeding risk than full-dose thrombolysis (RD\u2009=\u2009\u22120.23, 95% CI: \u22120.44 to \u22120.01). USAT significantly reduced 1-month mortality vs. anticoagulation alone (RD\u2009=\u2009\u22120.09, 95% CI: \u22120.13 to \u22120.04); however, this stems from a single non-randomized study requiring RCT validation. Bleeding rates showed no significant difference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with intermediate-risk PE, low-dose thrombolysis yields low mortality and recurrence rates with an acceptable bleeding risk. Compared with full-dose thrombolysis, it offers a safety advantage by reducing the incidence of bleeding; however, its comparative efficacy regarding mortality and recurrence remains undetermined and may be equivalent. Further high-quality RCTs are warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261284475<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1862385","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:32:17Z","timestamp":1786599137000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of low-dose thrombolysis in intermediate-risk pulmonary embolism: a meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Chen","family":"Zhu","sequence":"first","affiliation":[{"name":"Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingcong","family":"Wang","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Xing","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese 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