Mechanical Thrombectomy Versus Conventional Anticoagulants Alone in Treatment of Pulmonary Embolism: A Systematic Review and Meta‐Analysis

Pulmonary embolism (PE) is a life-threatening condition and a leading cause of sudden death. It occurs when a thrombus develops in the venous system and then dislodges to embolize into the pulmonary arteries, causing obstruction. The current mainstay of treatment is anticoagulation. Adjunct mechanical thrombectomy (MT) or pharmacological thrombolysis may be added, following a risk assessment, for intermediate to massive PE. However, physicians remain reluctant to adopt them as first-line treatment when comparing the benefits and risks to anticoagulation alone. This study aims to compare the safety and efficacy of MT with anticoagulation therapy alone in the treatment of intermediate to large-sized PE patients, focusing on hospital stay, ICU admission, morbidity, and mortality. Following PRISMA guidelines, a search was conducted on PubMed, Scopus, Web of Science, and Google Scholar for studies published from inception up to July 5, 2025. Studies were then screened based on predefined inclusion and exclusion criteria. The Newcastle-Ottawa Scale was used to assess the quality of evidence. Studies were required to report at least one of the following outcomes: mortality rate, hospital stay, overall complications, and ICU stay. Screening & data were extracted independently by eight co-authors, and a senior co-author resolved all conflicts. From a pool of 5661 studies, a total of six studies (1509 patients) were included. MT was associated with a trend toward lower all-cause mortality (OR = 0.5, 95% CI, 0.27 to 1.01; p = 0.05; I² = 46%) and a significantly lower rate of ICU length of stay by 3.0 days than those in the anticoagulant therapy group (MD: - 3.01, 95% CI, -5.57 to -0.44, p = 0.02; I² = 83%). No significant difference was found in overall complications and length of hospital stay between the MT and anticoagulant groups. However, MT was associated with lower rates of overall complications by 49% (OR = 0.51, 95% CI, 0.10 to 2.67, p = 0.43; I² = 83%) and shorter hospital stays (MD: -0.76; 95% CI, -4.64 to 3.13, p = 0.70; I² = 93%). MT showed greater efficacy in reducing mortality rates and ICU stay compared to intermediate to high-risk PE patients treated with conventional anticoagulant therapy.