Comparison of Treatment Result Between Anticoagulation Alone and Catheter-Directed Thrombolysis Plus Anticoagulation in Acute Lower Extremity Deep Vein Thrombosis

Abstract

Purpose Deep vein thrombosis (DVT) is the third most common cause of cardiovascular morbidity and mortality. Anticoagulation has been the primary treatment modality for acute DVT. However, catheter-directed thrombolysis (CDT) has recently become widely accepted as an additional therapy to anticoagulation. We assessed comparative outcomes in patients with acute DVT who underwent anticoagulation therapy alone (ACA) group and those treated with CDT group. Materials and Methods We retrospectively reviewed medical records of 149 patients with DVT from January 2011 to December 2015. We compared patients who received ACA group (n=120) and those who received CDT plus anticoagulation (CDT group, n=29). We analyzed the prevalence of lesions, thrombus removal rate in each lesion, and recurrence-free rate between the two groups. Results We found thrombus involvement in a total of 281 lesions in the ACA group and 85 lesions in the CDT group. For the distribution of lesions in each group, those in the femoral vein accounted for 34.2% of all lesions and those in the popliteal vein accounted for 31.7%. During follow-up, the overall thrombus removal rate was 91.1% in the ACA group and 87.0% in the CDT group (P=0.273). The recurrence-free rate was higher in the CDT group in a log-rank test; however, there was no statistically significant difference between the two groups (P=0.594). Conclusion According to our results, there was no significant difference in thrombus removal and recurrence-free rates between the CDT and ACA groups. ACA still has an important role in the treatment of DVT.

Exploring the Clinical Efficacy of Venous Thromboembolism Management in Saudi Arabian Hospitals: An Insight into Patient Outcomes

“…However, this study only included patients with proximal deep vein thrombosis and not all types of VTE. Another study by Young et al (2019) found that the use of anticoagulation therapy, including the use of oral anticoagulants, was associated with a lower risk of VTE recurrence, but this study did not compare the efficacy of anticoagulation therapy with that of thrombolytic therapy or catheter-directed thrombolysis [32].…”

Outcomes with catheter‐directed thrombolysis compared with anticoagulation alone in patients with acute deep venous thrombosis

“…Data for CDT in acute DVT treatment was conflicting because the evidence was difficult to interpret. Studies used different endovascular techniques, had different follow‐up periods, and showed conflicting results 5‐16 …”

“…Studies used different endovascular techniques, had different follow-up periods, and showed conflicting results. [5][6][7][8][9][10][11][12][13][14][15][16] When an acute DVT is not recanalized, the venous obstruction and resultant damage to the venous valves causes reflux, venous hypertension, and chronic inflammatory changes and scarring. 1,17,18 This is a set up for developing postthrombotic syndrome (PTS), the primary chronic sequela of DVT in 20-50% of the patients.…”

Clinical Observation of Uninterrupted Thrombolytic Therapy via Indwelling Catheter for Lower Limb Deep Vein Thrombosis

“…Du et al reported that anticoagulation plus CDT can more effectively improve venous patency and prevent PTS than anticoagulation alone. [14][15][16] CDT is usually used to treat acute femoral vein thrombosis, but few studies have reported the efficacy and safety of CDT, especially in the treatment of acute extensive lower extremity DVT. In contrast to proximal DVT, whether anticoagulation or other methods should be used for the treatment of distal DVT remains controversial.…”