A Review of the Effectiveness and Safety of Catheter-Directed Thrombolysis for Venous Thromboembolism

Abstract

Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity, mortality, and elevated healthcare costs. Between 20% and 50% of patients with lower extremity deep vein thrombosis will develop an advanced complication called post-thrombotic syndrome (PTS) within 2 years. Early mortality rates for DVT and acute high-risk pulmonary embolism are 3.8% and 38.9%, respectively. Additionally, PE is the most common and preventable cause of in-hospital death. Early removal of thrombus and improvement of vascular function can reduce the incidence of serious complications and mortality. Catheter-directed thrombolysis (CDT) involves the placement of a thrombolytic catheter into a venous thrombus, allowing the thrombolytic drug to act directly on the thrombus. Compared to conventional anticoagulation, CDT removes thrombus more rapidly, thereby enhancing venous function in the lower extremities and reducing pulmonary artery pressure. Compared to systemic thrombolytic therapy, CDT is safer, and complications from the procedure are uncommon. However, the risk of bleeding is slightly higher with CDT than with anticoagulation alone. In this review, we will discuss the pathophysiology of VTE and the technical advancements in CDT. We will also examine a selection of notable studies on CDT for the treatment of DVT in the lower extremities and PE in recent years, with the aim of integrating the findings. Clinical Impact Catheter-directed thrombolysis reduces the thrombolytic time and dose of thrombolytic drugs without affecting the thrombolytic effect to ensure that bleeding does not occur. This helps clinicians choose safer CDT treatments for their patients. We combine the historical process of catheter-directed thrombolytic therapy for VTE and prospect the future development of CDT.