Catheter-directed thrombolysis vs. anticoagulation for the prevention and treatment of post-thrombotic syndrome in deep vein thrombosis: An updated systematic review and meta-analysis of randomized trials

Abstract

Background Oral anticoagulation therapy was the mainstay of deep vein thrombosis treatment but recently, catheter-directed thrombolysis has emerged as an alternative. Objective To compare the efficacy and safety of the two strategies. Methods Medline, Embase and Cochrane CENTRAL were reviewed. Outcomes of interest included post-thrombotic syndrome, thromboembolic events, mortality, bleeding risk and iliofemoral patency. A random effects model meta-analysis was performed. Heterogeneity was assessed with I square. Results Four randomized controlled trials (RCTs) including 1005 patients met the inclusion criteria. Catheter-directed thrombolysis was more likely to prevent overall post-thrombotic syndrome compared to anticoagulation only (OR: 0.32; 95% CI: 0.12–0.85; I2=87.2%), and to lead to iliofemoral vein patency (OR: 2.7; 95% CI: 1.08–6.75; I2=55.3%) but no difference was noted in thromboembolic events (OR = 0.5; 95% CI: 0.08–3.02, I2=55.1%), bleeding and mortality rates. Conclusions Catheter-directed thrombolysis can decrease post-thrombotic syndrome rates and improve iliofemoral vein patency compared to anticoagulation when used for the treatment of deep vein thrombosis.

Venous thromboembolism in the era of COVID-19

“…It would be reasonable to assume that CDT might be associated with improved outcomes and less bleeding risk but this remains to be answered in the future. 67 Duration of anticoagulation therapy after PE/VTE confirmation in COVID-19 patients is usually three months of uninterrupted treatment with a direct oral anticoagulant as the drug of choice. However, this is right now based on the guidelines for patients with provoked DVT/PE and there are no data comparing a 3month vs a higher duration protocol.…”

“…It would be reasonable to assume that CDT might be associated with improved outcomes and less bleeding risk but this remains to be answered in the future. 67…”

Management of Acute Iliofemoral Deep Venous Thrombosis in Inflammatory Bowel Disease – Transitioning From Conservative Management to Early Intervention

“…Meta-analysis data have demonstrated that the incidence of PTS is lower following CDT in comparison to oral anticoagulation (odds ratio [OR]: 0.32; 95% confidence interval [CI]: 0.12-0.85, p = 0.022) [ 17 ]. This is further supplemented by guidance from the American College of Chest Physicians, American Heart Association, and the Society of Interventional Radiology who recommend CDT as an adjunct to anticoagulation rather than a standalone therapy [ 18 ], particularly in younger patients without major comorbidities and a long life-expectancy [ 12 , 19 , 20 ].…”

How Point-of-Care Ultrasound led to a diagnosis of May-Thurner Syndrome

“…Failure to treat MTS quickly could lead to post-thrombotic syndrome (PTS), which is thought to occur as a result of valvular incompetence and venous hypertension and leads to leg swelling and chronic skin changes such as hyperpigmentation, induration, and ulceration [5]. Meta-analysis has demonstrated the superiority of catheter-directed thrombolysis when compared to anticoagulation alone for the prevention and treatment of PTS [6].…”