Pharmacomechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Iliofemoral Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

Abstract

Early catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT) can reduce postthrombotic morbidity. Pharmacomechanical thrombolysis (PMT) is a new therapy that can be selected for the treatment of iliofemoral deep vein thrombosis (IFDVT). We performed a meta-analysis of clinical trials comparing PMT versus CDT for treatment of acute IFDVT. Literature on this topic published between January 1, 1990, and June 1, 2018, was identified using PubMed, Embase, Cochrane Library, and Web of Science. Six trials were included in the meta-analysis. Compared to CDT, PMT significantly reduced the Villalta score ( P = .007; I 2 = 0%), thrombus score ( P = .01; I 2 = 0%), the duration in the hospital ( P = .03; I 2 = 64%), and thrombolysis time ( P < .00001, I 2 = 0%). There was no significant difference in valvular incompetence events ( P = .21; I 2 = 0%), minor bleeding events ( P = .59; I 2 = 0%), stent events ( P = .09; I 2 = 24%), and clot reduction grade I events ( P = .16; I 2 = 43%) between PMT and CDT. Subgroup analysis was performed by dividing the clot reduction grade I events group into PMT plus CDT versus CDT group and significant differences were found ( P = .03, I 2 = 0%) as well as for PMT alone versus CDT group ( P = .88, I 2 = 37%). This meta-analysis shows that PMT reduces the severity of postthrombotic syndrome (PTS), thrombus score, duration in hospital, and thrombolysis time compared to CDT. More specifically, PMT plus CDT reduces clot reduction grade I events. No significant difference in valvular incompetence events, stent events, and minor bleeding events were found when PMT was compared to CDT.

Global guidelines trends and controversies in lower limb venous and lymphatic disease

“…251 A review of six studies, all comparing experimental groups receiving pharmaco-mechanical thrombectomy and control groups receiving catheter-directed thrombolysis for ilio-femoral deep venous thrombosis, showed that pharmaco-mechanical thrombectomy reduces the severity of post-thrombotic syndrome, thrombus score, duration in hospital and thrombolysis time compared to catheter-directed thrombolysis. 252 A second systematic review evaluated 15 retrospective investigations and one prospective registry comparing pharmaco-mechanical thrombectomy and catheterdirected thrombolysis. Of these investigations, seven reported comparative evidence of pharmacomechanical thrombectomy versus catheter-directed thrombolysis.…”

Tratamiento farmacomecánico dirigido por catéter de la trombosis venosa profunda: informe de casos

“…La escala de Villalta se aplicó a 75% de los pacientes, casi 30% sin SPT y apenas alrededor del 3% con SPT grave. Esto corresponde con los informes de Tan, et al 33 quienes en un metaanálisis de 2019 con seis estudios y 350 pacientes encontraron que la TFM redujo la calificación de Villalta, en comparación con la TDC sola. Los resultados de los autores son inferiores a lo notificado en un estudio mexicano que comparó el uso de TDC con anticoagulación para reducir el SPT y en el que cerca del 60% de los pacientes a dos años no presentó SPT 19 .…”

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].…”