Efficacy and safety of thrombolysis for pediatric venous thromboembolism: a systematic review and meta-analysis.

This systematic reviewaddresses mortality, VTE resolution, recurrence, bleeding, and organ-specific outcomes in 5 PICO (population, intervention, comparison, outcomes) questions on thrombolysis across pulmonary embolism (PE), extremity deep vein thrombosis (DVT), right atrial thrombosis (RAT), cerebral sinus venous thrombosis (CSVT), and renal vein thrombosis (RVT).

本系统评价针对5个PICO（人群、干预措施、对照、结果）问题，探讨了在肺栓塞（PE）、肢体深静脉血栓形成（DVT）、右心房血栓（RAT）、脑静脉窦血栓形成（CSVT）和肾静脉血栓形成（RVT）中，溶栓后抗凝与单独抗凝治疗在死亡率、VTE解决、复发、出血和器官特异性结果方面的差异。

Meta-analysisreported risk ratios or differences (95% confidence intervals [CIs]), and absolute effects per 1000 patients.

荟萃分析报告了风险比或差异（95%置信区间[CI]），以及每1000名患者中的绝对效应。

Certainty of evidence was assessed using GRADE (Grading of recommendation, assessment, Development, and Evaluation) guidelines.

使用GRADE（推荐等级、评估、发展和评估）指南评估了证据的确定性。

Thirteen nonrandomized studies were included and no randomized clinical trials addressed these questions.

纳入了13项非随机研究，但没有随机临床试验解决这些问题。

Thrombolysis might be associated with a higher risk of major bleeding, clinically relevant nonmajor bleeding, or unspecified bleeding with risk differences of 0.09 (95% CI, -0.06 to 0.23), 0.06 (95% CI, -0.11 to 0.22), and 0.09 (95% CI, -0.04 to 0.23), respectively.

溶栓治疗可能与主要出血、临床相关的非主要出血或未指定出血的风险较高有关，风险差异分别为0.09（95%置信区间，-0.06至0.23）、0.06（95%置信区间，-0.11至0.22）和0.09（95%置信区间，-0.04至0.23）。

In PE with hemodynamic compromise, thrombolysis might be associated with a lower risk of mortality but conclusions on PE progression were uncertain in submassive PE.

在血流动力学受损的肺栓塞（PE）患者中，溶栓治疗可能与较低的死亡风险相关，但在亚大面积肺栓塞中，关于PE进展的结论尚不确定。

In DVT, thrombolysis may have little to no effect on mortality or thrombus resolution but might be associated with lower risk of postthrombotic syndrome.

在深静脉血栓形成（DVT）中，溶栓治疗对死亡率或血栓溶解可能影响不大，但可能与较低的血栓后综合症风险相关。

In RAT, thrombolysis might have little to no effect on thrombus resolution but a higher risk of major bleeding and mortality.

在RAT中，溶栓治疗对血栓溶解可能几乎没有效果，但会增加主要出血和死亡的风险。

For CSVT and RVT, the evidence was very limited.

对于CSVT和RVT，证据非常有限。

These findings were based on very-low-certainty evidence because of confounding and imprecision from small sample sizes.

这些发现基于非常低质量的证据，原因在于混杂因素和小样本量导致的不精确性。

This systematic reviewhighlights key challenges in developing recommendations for thrombolysis in children with VTE.

这项系统综述突出了在为儿童静脉血栓栓塞症（VTE）患者制定溶栓治疗建议时面临的关键挑战。