Pharmacomechanical Thrombolysis of Acute and Chronic Symptomatic Deep Vein Thrombosis: A Systematic Review of Literature

Abstract

Pharmacomechanical thrombolysis (PMT) is an emerging treatment option for symptomatic deep vein thrombosis (DVT). This may obviate the need for systemic or catheter-directed thrombolysis. PubMed, EMBASE, and Cochrane database search of PMT in acute and chronic symptomatic DVT was undertaken. Baseline demographic and clinical characteristics, procedural details, DVT characteristics, and procedural and clinical outcomes are presented. A total of 8 case series (n = 2528; 1998-2009) qualified for inclusion. Lower extremity symptomatic DVTs constituted the majority of the cases (>80%). Both acute (<14 days) and chronic (>14 days) DVTs were included. Procedural success was 59% to 100% and catheter-directed thrombolysis was used as an adjunct in 16% to 53%. No deaths or major bleeding complications were reported. Pharmacomechanical thrombolysis leads to the immediate resolution of clinical symptoms of DVT in the majority of patients. Pharmacomechanical thrombolysis may be a safe and novel method, when appropriate expertise and resources are available, for the treatment of symptomatic acute and chronic DVT.

Endovascular Management of Deep Vein Thrombosis with Rheolytic Thrombectomy: Final Report of the Prospective Multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) Registry

“…The observed arrhythmias were self-limited and resolved when rheolysis was paused. The PEARL registry findings are consistent with those reported in recent systematic literature reviews of PCDT and CDT (18,26).…”

Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum

“…Large multicenter randomized clinical trials are lacking, and existing series have often included diverse patients and have largely evaluated only technical outcome measures. 16,17,74 Despite these obvious deficiencies, systematic review of studies comparing these strategies with conventional anticoagulation does suggest some benefit with respect to reducing the incidence of the postthrombotic syndrome. 19 Successful application of any of these strategies requires careful patient selection as well as a consideration of the patient's underlying values and preferences.…”

“…These approaches, which include rotational, rheolytic, and ultrasound-assisted devices, are collectively referred to as pharmacomechanical thrombolysis. 17,74 Limited data suggest that these devices should be used in conjunction with pharmacologic lytic agents, significant lysis (Ͼ50%) being achieved in only one-third of patients treated with mechanical devices alone. 70 The use of mechanical devices alone, without the concurrent use of thrombolytic drugs, cannot be routinely recommended.…”

“…17 A similar systematic review of eight cases series also found no major periprocedural bleeding complications or deaths. 74 Although randomized clinical trials are lacking, two small cohort studies compared pharmacomechanical thrombolysis with catheter-directed pharmacologic thrombolysis. Lin et al reported that although rates of complete thrombolysis were similar for pharmacomechanical and catheter-directed pharmacologic thrombolysis (75% vs 70%), infusion times (76 Ϯ 34 minutes vs 18 Ϯ 8 hours) and costs (mean cost difference $37, 609) were significantly less with pharmacomechanical thrombolysis.…”

Pharmacomechanical Thrombolysis of Symptomatic Acute and Subacute Deep Vein Thrombosis with a Rotational Thrombectomy Device

“…A retrospective study by Rao et al (12) demonstrated that thrombolytic agent doses and infusion durations were reduced with PMT compared with conventional CDT. No major bleeding complications were reported in a systematic literature review of 2,528 patients with DVT treated with PMT (18). PMT may also decrease the risk of hemorrhagic complications because of its shorter infusion intervals and lower doses of thrombolytic agents, making it a more attractive modality in highrisk cases in postoperative patients.…”