Catheter‐directed thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: A systematic review

Abstract

Methods of delivery of thrombolytic agents for massive or limb threatening deep venous thrombosis (DVT) include a systemic infusion, local-regional administration, and catheter-directed therapy (tip of catheter placed inside the thrombus). We evaluated the effectiveness of catheter-directed therapy and compared the results with randomized clinical trials of systemic and local-regional thrombolytic therapy. Many who used catheter-directed thrombolysis used balloon angioplasty, stents, or thrombectomy in addition. Pooled data showed higher rates of complete early opening of occluded veins with catheter-directed thrombolysis alone, 90%, or with catheter-directed thrombolysis often followed by adjunct therapy, 76%, than with a systemic infusion, 28%, or local-regional administration, 20%. The prevalence of postthrombotic syndrome was lower with catheter-directed combined with adjunct therapy, 26%, compared with 56% and 69%, respectively. Rates of any bleeding were higher with catheter-directed thrombolytic therapy, but bleeding was usually minor. In conclusion, the data suggest that catheter-directed thrombolytic therapy may be more beneficial than systemic or local regional administration. An advantage is that it lends itself to adjunct treatment following the administration of thrombolytic agents if the thrombolysis is inadequate.

Catheter-directed thrombolysis in the treatment of acute deep venous thrombosis: a meta-analysis

“…Enden et al (2009) performed an RCT and showed that CDT combined with anticoagulant therapy significantly improved the rate of iliac and femoral vein patency over anticoagulant therapy alone. The number of published RCTs of CDT increased as European and American experts on the treatment of DVT rigorously evaluated the efficacy of CDT, and meta-analyses and systematic reviews of this topic have also been published (Janssen et al, 2005;Alesh et al, 2007;Vedantham, 2010). The results of these analyses have confirmed the efficacy of CDT, and Vedantham (2010) went so far as to state that CDT should be the preferred treatment for acute iliofemoral venous thrombosis.…”

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

“…Carefully selected patients with low bleeding risk (often younger patients) with extensive proximal iliofemoral DVT may benefit from thrombolysis, particularly CDT, in which bleeding rates are lower than the systemic thrombolytic therapy [143][144][145][146]. CDT should be considered for patients with symptomatic iliofemoral DVT who have symptoms of less than 14-day duration, good functional status, a life expectancy of 1 year or more and a low risk of bleeding.…”

Thrombolytic therapy is effective in paroxysmal nocturnal hemoglobinuria: a series of nine patients and a review of the literature

“…23,25,26,29,30 Indeed, catheter-directed therapy is gaining in acceptance for the treatment of deep vein thrombosis of the extremities. 29,30 However, there has been no trial comparing catheter-directed therapy versus systemic tPA.…”

“…23,25,26,29,30 Indeed, catheter-directed therapy is gaining in acceptance for the treatment of deep vein thrombosis of the extremities. 29,30 However, there has been no trial comparing catheter-directed therapy versus systemic tPA. The use of catheter-directed therapy has also been emphasized with respect to Budd-Chiari syndrome, and it has been claimed that systemic thrombolytic therapy is not effective for this condition, based on two out of three patients who did not respond.…”

“…These agents also have a role in patients who have had arterial cerebral vascular accidents, 21,22 in patients who are in hemodynamic shock from pulmonary emboli, and in patients with venous thrombosis at other sites. [23][24][25][26][27][28]29,30 As for PNH, there have been a number of papers in the literature, [10][11][12][13][14][15][17][18][19]31,32 most of them on isolated cases. Here we report our experience with thrombolytic therapy in a highly selected group of nine patients with PNH, all of whom had severe thrombotic complications, which were regarded as potentially fatal if not treated, or which were progressing despite anticoagulation: in this respect, tissue plasminogen activator (tPA) can be regarded as a second-line treatment for patients with PNH complicated by venous thrombosis.…”