Catheter-Directed Thrombolysis Along with Mechanical Thromboaspiration versus Anticoagulation Alone in the Management of Lower Limb Deep Venous Thrombosis—A Comparative Study

Abstract

Catheter-directed thrombolysis (CDT) with assisted mechanical thrombolysis is now considered as the standard of medical care for deep vein thrombosis (DVT). The study was conducted to describe the immediate and long-term (6 months) safety and effectiveness of CDT in patient with lower limb DVT compared with the routine anticoagulation alone. All 12 to 85 years old patients with recent (0?8 weeks) DVT were included. In CDT group, thrombus was aspirated mechanically and streptokinase (STK) was given along with unfractionated heparin (UFH). After 6 months, deep venous patency and postthrombotic syndrome (PTS) was assessed by using duplex ultrasound and Villalta scale, respectively. Among 51 patients with completed data, 25 patients were allocated additional CDT given for a mean duration of 108???32 hours and 26 patients were allocated standard treatment alone. Grade III (complete) lysis was achieved in 37% patients and grade II (50?90%) lysis in 63% of patients. Patients with partial lysis underwent percutaneous transluminal angioplasty and/or venous stenting. After 6 months, iliofemoral patency was found in 20 (80%) in the CDT group versus 7 (23%) in anticoagulation alone group (p?<?0.01). PTS was seen in 5 (20%) in the CDT group versus 19 (77%) in anticoagulation alone group (p?<?0.01). We conclude that CDT and conventional manual aspiration thrombectomy are an effective treatment for lower extremity DVT. STK infusion can be safely given up to 6 days. As addition of UFH can cause thrombocytopenia, so daily monitoring of complete blood counts is needed during CDT.

Endovascular treatment of iliofemoral deep venous thrombosis: is there enough evidence to support it? A systematic review with meta-analysis

“…The primary endpoint of this study was to determine the efficacy of PMT (CDT and mechanical thromboaspiration) in comparison to standard anticoagulation alone. 8 Kuo et al included 61 patients with acute ilieofemoral DVT in a prospective study with the main objective of comparing the efficacy, long-term outcomes and complications of CDT and PMT treatment. 5 In this trial, performed in 2016, 3 patients were submitted to CDT and 31 patients were submitted to PMT, pursuant to each patient's decision.…”

“…The risk of bias assessment of the 4 included randomized clinical trials and the 5 non-randomized comparative studies is presented in Table I, II, 5,8,9,[11][12][13][14] respectively.…”

“…In case of disagreement, a third reviewer was responsible for the analysis of the study and extracted data in cause and a team discussion was made in order to achieve common Table II.-Risk of bias assessment of the included nonrandomized clinical trials, according to the NewCastle Ottawa Scale (NOS). 5,8,9,13,14 Srinivas et al 8 Kuo et al 5 lin et al 13 Huang et al 9 Martinez et al 14 good quality: 3 or 4 stars in selection domain aND 1 or 2 stars in comparability domain aND 2 or 3 stars in outcome/exposure domain; Fair quality: 2 stars in selection domain aND 1 or 2 stars in comparability domain aND 2 or 3 stars in outcome/exposure domain; Poor quality: 0 or 1 star in selection domain or 0 stars in comparability domain or 0 or 1 stars in outcome/exposure domain.…”

“…The most relevant characteristics of each of these studies are described in Table III. 2,4,5,8,9,[11][12][13][14] CaVenT 2 and Haig et al 11 are two different trials that studied the same baseline population. In order to avoid including duplicated data in the statistical analysis, we only included Haig et al 11 data in the meta-analysis, because of the longer follow-up period of this study.…”

“…From these studies, 4 are prospective randomized clinical trials, 2 are nonrandomized prospec- Table III.-Baseline characteristics of the included studies for meta-analysis. 2,4,5,8,9,[11][12][13][14] evaluated the clinical records of all patients with symptomatic lower leg DVT undergoing CDT or PMT interventions for a 8 year period. 13 A total of 93 patients who were submitted to these endovascular procedures were included in the study.…”