Mechanical Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolism: A Systematic Review and Meta-Analysis.

PURPOSE: We performed a systematic review and meta-analysis comparing mechanical thrombectomy to anticoagulation in patients with intermediate-risk pulmonary embolism (PE) focusing on patient-centred outcomes.

MATERIALS AND

METHODS

PubMed, Embase and Cochrane databases were searched from inception to November 2025 for randomised controlled trials and observational studies comparing mechanical thrombectomy (with or without anticoagulation) to anticoagulation alone in patients with intermediate-risk PE. The main outcomes were all-cause in-hospital mortality, all-cause 30-day mortality, hospital length of stay and ICU length of stay.

RESULTS

We identified seven studies, comprising 2699 patients from one randomised controlled trial and six observational studies. Mechanical thrombectomy, compared to anticoagulation, was associated with significantly lower incidence of all-cause 30-day mortality (OR 0.09; 95% CI 0.02-0.41; p = 0.002; I2 = 0%). There was no difference in all-cause in-hospital mortality (OR 0.62; 95% CI 0.19-2.03; p = 0.29; I2 = 23%), hospital length of stay (mean difference - 1.85 days; 95% CI - 4.60 to 0.89 days; p = 0.13; I2 = 91%) or ICU length of stay (mean difference - 0.48 days; 95% CI - 2.62 to 1.67 days; p = 0.53; I2 = 84%).

CONCLUSION

In patients with intermediate-risk PE, mechanical thrombectomy was associated with a lower incidence of all-cause 30-day mortality compared to anticoagulation. However, as the majority of the included studies were observational, these findings should be interpreted with caution and warrant confirmation with further high-quality randomised controlled trials.