Catheter-Directed Thrombolysis Versus Standard Anticoagulation for Acute Lower Extremity Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

Abstract

Standard anticoagulant treatment alone for acute lower extremity deep vein thrombosis (DVT) is ineffective in eliminating thrombus from the deep venous system, with many patients developing postthrombotic syndrome (PTS). Because catheter-directed thrombolysis (CDT) can dissolve the clot, reducing the development of PTS in iliofemoral or femoropopliteal DVT. This meta-analysis compares CDT plus anticoagulation versus standard anticoagulation for acute iliofemoral or femoropopliteal DVT. Ten trials were included in the meta-analysis. Compared with anticoagulant alone, CDT was shown to significantly increase the percentage patency of the iliofemoral vein ( P < .00001; I = 44%) and reduce the risk of PTS ( P = .0002; I = 79%). In subgroup analysis of randomized controlled trials, CDT was not shown to prevent PTS ( P = .2; I = 59%). A reduced PTS risk was shown, however, in nonrandomized trials ( P < .00001; I = 47%). Meta-analysis showed that CDT can reduce severe PTS risk ( P = .002; I = 0%). However, CDT was not indicated to prevent mild PTS ( P = .91; I = 79%). A significant increase in bleeding events ( P < .00001; I = 33%) and pulmonary embolism (PE) ( P < .00001; I = 14%) were also demonstrated. However, for the CDT group, the duration of stay in the hospital was significantly prolonged compared to the anticoagulant group ( P < .00001; I = 0%). There was no significant difference in death ( P = .09; I = 0%) or recurrent venous thromboembolism events ( P = .52; I = 58%). This meta-analysis showed that CDT may improve patency of the iliofemoral vein or severe PTS compared with anticoagulation therapy alone, but measuring PTS risk remains controversial. However, CDT could increase the risk of bleeding events, PE events, and duration of hospital stay.

The ATTRACT Trial Becomes More Attractive

“…Indeed, the heterogeneity of data in many publications regarding endovenous thrombolysis makes even meta-analysis of these outcomes difficult. 8 A further observation is that the rate of PTS in the ATTRACT trial in the PCDT arm is higher than previous publications and, in particular, when compared with that of large volume centres with long experience. The Copenhagen group demonstrated a rate of any PTS of 17% in 109 patients with iliofemoral DVT treated with catheter-directed thrombolysis (CDT) after a median follow up of 71 months.…”

Single-Session Percutaneous Mechanical Thrombectomy Using the Aspirex®S Device Plus Stenting for Acute Iliofemoral Deep Vein Thrombosis: Safety, Efficacy, and Mid-Term Outcomes

“…However, to date, endovascular treatment options for the management of acute iliofemoral DVT remain controversial because of inconclusive study results [16][17][18][19][20]. Indeed, several studies reported results of CDT and PMT in the literature [6][7][8][9][10][11][12][16][17][18][19][20]. The randomized controlled CaVenT trial included 189 patients with acute iliofemoral DVT divided into 2 groups as anticoagulant therapy alone and anticoagulant therapy plus CDT [19].…”

Effificacy of Thrombolytic Therapy Applied Through Foot Veins in Lower Extremity Acute and Subacute Deep Vein Thrombosis

“…DVT'nin tedavisinde antikoagülan kullanımı altın standart olmasına rağmen, antikoagülan kullanımının tek başına derin venlerde tam açıklık sağlayamadığı bilinmektedir. 7 Bu nedenle trombolitik ajanın direkt trombüs içine uygulandığı yöntemler son yıllarda popüler hâle gelmiş ve yaygın uygulanır olmuştur. Genellikle anjiyografi ünitelerinde skopi eşliğinde ve USG kılavuzluğunda IV kateter uygulaması gerektiren kateter aracılı tromboliz, farmakomekanik kateter aracılı tromboliz veya venöz anjiyoplasti/stentleme yöntemleri kullanılmaktadır.…”