Outcomes with catheter-directed thrombolysis compared with anticoagulation alone in patients with acute deep venous thrombosis.
catheter-directed thrombolysis
deep venous thrombosis
post-thrombotic syndrome
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
01 01 2021
01 01 2021
Historique:
received:
18
03
2020
revised:
29
07
2020
accepted:
03
08
2020
pubmed:
17
9
2020
medline:
25
9
2021
entrez:
16
9
2020
Statut:
ppublish
Résumé
The authors aimed to investigate the benefits and risks of catheter-directed thrombolysis (CDT) in acute deep venous thrombosis (DVT). The role of CDT in the management of DVT is evolving. Data on CDT versus anticoagulation alone in acute DVT is sparse. We performed a systematic review and meta-analysis of published studies that compared CDT to anticoagulation alone in patients with acute DVT. We included 11 studies (four randomized control trials [RCTs] and seven observational studies) with a total of 8,737 patients. During hospital stay, patients who received CDT had higher odds of major bleeding (2.5% vs. 1.6%; OR 1.46, 95% CI [1.07, 1.98], p = .02), blood transfusion (10.8% vs. 6.2%; OR 1.8, 95% CI [1.52, 2.13], p < .001), and thromboembolism (15.5% vs. 10%; OR 1.67, 95% CI [1.47, 1.91], p < .001) compared with anticoagulation alone. At 6-month follow-up, patients who received CDT had higher venous patency (71.1% vs. 37.7%; OR 5.49, 95% CI [2.63, 11.5], p < .001) and lower postthrombotic syndrome (PTS; 27% vs. 40.7%; OR 0.44, 95% CI [0.22, 0.86], p = .02). During a mean follow-up duration of 30.5 ± 28 months, CDT group continued to have higher venous patency (79.6% vs. 71.8%; OR 3.79, 95% CI [1.54, 9.32], p = .004) and lower PTS (44.7% vs. 50.5%; OR 0.43, 95% CI [0.23, 0.78], p = .006), but no difference in thromboembolism. Compared with anticoagulation alone, CDT for patients with acute DVT was associated with a higher risk of complications, but a higher rate of venous patency and lower risk of postthrombotic syndrome at 2.5 years follow-up.
Sections du résumé
OBJECTIVE
The authors aimed to investigate the benefits and risks of catheter-directed thrombolysis (CDT) in acute deep venous thrombosis (DVT).
BACKGROUND
The role of CDT in the management of DVT is evolving. Data on CDT versus anticoagulation alone in acute DVT is sparse.
METHODS
We performed a systematic review and meta-analysis of published studies that compared CDT to anticoagulation alone in patients with acute DVT.
RESULTS
We included 11 studies (four randomized control trials [RCTs] and seven observational studies) with a total of 8,737 patients. During hospital stay, patients who received CDT had higher odds of major bleeding (2.5% vs. 1.6%; OR 1.46, 95% CI [1.07, 1.98], p = .02), blood transfusion (10.8% vs. 6.2%; OR 1.8, 95% CI [1.52, 2.13], p < .001), and thromboembolism (15.5% vs. 10%; OR 1.67, 95% CI [1.47, 1.91], p < .001) compared with anticoagulation alone. At 6-month follow-up, patients who received CDT had higher venous patency (71.1% vs. 37.7%; OR 5.49, 95% CI [2.63, 11.5], p < .001) and lower postthrombotic syndrome (PTS; 27% vs. 40.7%; OR 0.44, 95% CI [0.22, 0.86], p = .02). During a mean follow-up duration of 30.5 ± 28 months, CDT group continued to have higher venous patency (79.6% vs. 71.8%; OR 3.79, 95% CI [1.54, 9.32], p = .004) and lower PTS (44.7% vs. 50.5%; OR 0.43, 95% CI [0.23, 0.78], p = .006), but no difference in thromboembolism.
CONCLUSION
Compared with anticoagulation alone, CDT for patients with acute DVT was associated with a higher risk of complications, but a higher rate of venous patency and lower risk of postthrombotic syndrome at 2.5 years follow-up.
Substances chimiques
Anticoagulants
0
Fibrinolytic Agents
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
E61-E70Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Kahn SR, Comerota AJ, Cushman M, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2014;130(18):1636-1661.
Fleck D, Albadawi H, Shamoun F, Knuttinen G, Naidu S, Oklu R. Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Therapy. 2017;7(suppl. 3):S228-S237.
Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-352.
Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ. Executive summary: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(suppl 2):7S-47S.
Choi YJ, Kim DH, il Kim D, Kim H-Y, Lee SS, Jung HJ. Comparison of treatment result between anticoagulation alone and catheter-directed thrombolysis plus anticoagulation in acute lower extremity deep vein thrombosis. Vasc Special Int. 2019;35(1):28-33.
Kim Y-A, Yang S-S, Yun W-S. Does catheter-directed thrombolysis prevent postthrombotic syndrome? Vasc Special Int. 2018;34(2):26-30.
Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med. 2017;377(23):2240-2252.
Ezelsoy M, Turunc G, Bayram M. Early outcomes of pharmacomechanical thrombectomy in acute deep vein thrombosis patients. Heart Surg Forum. 2015;18:E222-E225.
Bashir R, Zack CJ, Zhao H, Comerota AJ, Bove AA. Comparative outcomes of catheter-directed thrombolysis plus anticoagulation vs anticoagulation alone to treat lower-extremity proximal deep vein thrombosis. JAMA Intern Med. 2014;174(9):1494-1501.
Srinivas B, Patra S, Nagesh C, Reddy B, Manjunath C. Catheter-directed thrombolysis along with mechanical thromboaspiration versus anticoagulation alone in the management of lower limb deep venous thrombosis: a comparative study. Int J Angiol. 2014;23(04):247-254.
Lee C-Y, Lai S-T, Shih C-C, Wu T-C. Short-term results of catheter-directed intrathrombus thrombolysis versus anticoagulation in acute proximal deep vein thrombosis. J Chin Med Assoc. 2013;76(5):265-270.
Enden T, Haig Y, Kløw N-E, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. 2012;379(9810):31-38.
Haig Y, Enden T, Grøtta O, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol. 2016;3(2):e64-e71.
Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur J Vasc Endovasc Surg. 2002;24(3):209-214.
AbuRahma AF, Perkins SE, Wulu JT, Ng HK. Iliofemoral deep vein thrombosis: conventional therapy versus lysis and percutaneous transluminal angioplasty and stenting. Ann Surg. 2001;233(6):752-760.
Schweizer J, Kirch W, Koch R, et al. Short-and long-term results after thrombolytic treatment of deep venous thrombosis. J Am Coll Cardiol. 2000;36(4):1336-1343.
Carman TL. Prevention of the post-thrombotic syndrome. Curr Treat Options Cardiovasc Med. 2016;18(8):51.
Kahn SR, Shapiro S, Wells PS, et al. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet. 2014;383(9920):880-888.
Kahn SR. The post-thrombotic syndrome. Hematol Am Soc Hematol Educ Program. 2016;2016(1):413-418.
Kahn S, Shbaklo H, Lamping D, et al. Determinants of health-related quality of life during the years following deep vein thrombosis. J Thromb Haemost. 2008;6(7):1105-1112.
Wik HS, Ghanima W, Sandset PM, Kahn SR. Scoring systems for postthrombotic syndrome. Semin Thromb Hemost. 2017;43(5):500-504.
Nathan AS, Giri J. Reexamining the open-vein hypothesis for acute deep venous thrombosis. Am Heart Assoc. 2019;139:1174-1176.
Ali ANA, Avgerinos ED, Chaer RA. Role of venous stenting for iliofemoral and vena cava venous obstruction. Surg Clin. 2018;98(2):361-371.
Wells GA, Tugwell P, O'Connell D, Welch V, Peterson J, Shea B, Losos M. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. www.ohri.ca/programs/clinical_epidemiology/oxford.htm. 2015.
Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-634.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Jama. 2000;283(15):2008-2012.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-269.
Vedantham S, Thorpe PE, Cardella JF, et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Intervent Radiol. 2009;20(suppl 7):227-239.
Meissner MH, Gloviczki P, Comerota AJ, et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2012;55(5):1449-1462.
Group PS. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study. Circulation. 2005;112(3):416-422.
Klein SJ, Gasparis AP, Virvilis D, Ferretti JA, Labropoulos N. Prospective determination of candidates for thrombolysis in patients with acute proximal deep vein thrombosis. J Vasc Surg. 2010;51(4):908-912.
Comerota AJ. Thrombolysis for deep venous thrombosis. J Vasc Surg. 2012;55(2):607-611.
Goktay AY, Senturk C. Endovascular treatment of thrombosis and embolism. Thrombosis and embolism: from research to clinical practice. New York, NY: Springer; 2016:195-213.