Catheter-directed thrombolysis for patients with acute lower extremity deep vein thrombosis: a meta-analysis

Abstract

Objectives: To evaluate case series studies that quantitatively assess the effects of catheter-directed thrombolysis (CDT) and compare the efficacy of CDT and anticoagulation in patients with acute lower extremity deep vein thrombosis (DVT). Methods: Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE and Scopus, were searched through January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated with CDT or with anticoagulation. In the case series studies, the pooled estimates of efficacy outcomes for patency rate, complete lysis, rethrombosis and post-thrombotic syndrome (PTS) were calculated across the studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated. Results: Twenty-five articles (six comparing CDT with anticoagulation and 19 case series) including 2254 patients met the eligibility criteria. In the case series studies, the pooled results were a patency rate of 0.87 (95% CI: 0.85-0.89), complete lysis 0.58 (95% CI: 0.40-0.75), rethrombosis 0.11 (95% CI: 0.06-0.17) and PTS 0.10 (95% CI: 0.08-0.12). Six studies comparing the efficacy outcomes of CDT and anticoagulation showed that CDT was associated with a reduction of PTS (OR 0.38, 95%CI 0.26-0.55, p<0.0001) and a higher patency rate (OR 4.76, 95%CI 2.14-10.56, p<0.0001). Conclusion: Acute lower extremity DVT patients receiving CDT were found to have a lower incidence of PTS and a higher incidence of patency rate. In our meta-analysis, CDT is shown to be an effective treatment for acute lower extremity DVT patients.

The cumulative venous thromboembolism incidence and risk factors in intensive care patients receiving the guideline-recommended thromboprophylaxis

“…Proximal DVT was defined as the thrombus involving at least the femoral vein and above; meanwhile, the thrombus may also involve the popliteal vein or (and) calf vein. [11–13] VTE was defined as proximal DVT (both symptomatic and asymptomatic), symptomatic distal DVT, and PE. [14,15]…”

<p>Iliac vein compression: epidemiology, diagnosis and treatment</p>

“…At this time, femoropopliteal DVT are best treated with anticoagulation only. A recent metanalysis comparing CDT with anticoagulation in treating iliofemoral DVT has shown an odds ratio of 0.38 (95% CI, 0.26–0.55) for development of PTS with CDT compared to anticoagulation only 32. Also, the patency rate after CDT was much higher at 6-month (OR 4.76, 95% CI, 2.14–10.56) ( p <0.0001).…”

Outcome of Acute Deep Venous Thrombosis Using Standard Treatment versus Thrombolytics: A Literature Review

“…DVT treatment includes anticoagulant therapy, pharmacologic thrombolysis (systemic thrombolysis, flow-directed thrombolysis, and catheter-directed thrombolysis), percutaneous mechanical thrombectomy, surgical thrombectomy and physical therapy 3 . Current guideline of antithrombotic therapy for VTE disease suggests that acute lower extremity DVT patients are most likely to benefit from thrombolytic therapy due to its efficacy 13 , 19 .…”

“…They may be administered using different doses and durations as well as different route of administration. The theoretical advantage behind the loco/regional and catheter-directed methods is that they may reduce the necessary amount of thrombolytic (uses lower doses) and may reduce the risk of bleeding compared to systemic route 6 .…”