Thrombolysis for acute deep vein thrombosis

Abstract

Background Standard treatment for deep vein thrombosis aims to reduce immediate complications. Use of thrombolysis or clot dissolving drugs could reduce the long-term complications of post-thrombotic syndrome (PTS) including pain, swelling, skin discolouration, or venous ulceration in the affected leg. This is the third update of a review first published in 2004. Objectives To assess the effects of thrombolytic therapy and anticoagulation compared to anticoagulation alone for the management of people with acute deep vein thrombosis (DVT) of the lower limb as determined by the effects on pulmonary embolism, recurrent venous thromboembolism, major bleeding, post-thrombotic complications, venous patency and venous function. Search methods For this update the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (February 2016). In addition the CIS searched the Cochrane Register of Studies (CENTRAL (2016, Issue 1)). Trial registries were searched for details of ongoing or unpublished studies. Selection criteria Randomised controlled trials (RCTs) examining thrombolysis and anticoagulation versus anticoagulation for acute DVT were considered. Data collection and analysis For this update (2016), LW and CB selected trials, extracted data independently, and sought advice from MPA where necessary. We assessed study quality with the Cochrane risk of bias tool. For dichotomous outcomes, we calculated the risk ratio (RR) and corresponding 95% confidence interval (CI). Data were pooled using a fixed-effect model unless significant heterogeneity was identified in which case a random-effects model was used. GRADE was used to assess the overall quality of the evidence supporting the outcomes assessed in this review. Main results Seventeen RCTs with 1103 participants were included. These studies differed in the both thrombolytic agent used and in the technique used to deliver it. Systemic, loco-regional and catheter-directed thrombolysis (CDT) were all included. Fourteen studies were rated as low risk of bias and three studies were rated as high risk of bias. We combined the results as any (all) thrombolysis compared to standard anticoagulation. Complete clot lysis occurred significantly more often in the treatment group at early follow-up (RR 4.91; 95% CI 1.66 1 Thrombolysis for acute deep vein thrombosis (Review)

Deep Vein Thrombosis Interventions in Cancer Patients

“…11 However, there is also a significantly increased risk of bleeding complications (RR: 2.23, 95% CI: 1.41-3.52) with CDT, including fatal or intracranial bleeding. The degree of residual clot following CDT has been correlated with the risk for developing PTS.…”

Trombo flutuante em veia femoral

“…13 Thrombolytic treatment effectively dissolves the thrombus and reduces postthrombotic syndrome (RR: 0.66; 95%CI: 0.47-0.94), but it is associated with a higher frequency of hemorrhagic complications. 12 The ATTRACT study 18,19 randomized 692 patients with proximal DVT for fibrinolytic treatment or conventional treatment (anticoagulants and elastic stockings). After 2 years it was observed that fibrinolytic treatment did not prevent postthrombotic syndrome, but did reduce its severity in 25% of cases (18% vs. 24%).…”

“…Possible treatment options that were considered for these cases included: anticoagulant treatment 3,11 ; fibrinolytic treatment or thrombolysis 12 ; and inferior vena cava filter (VCF).…”

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

“…Carefully selected patients with low bleeding risk (often younger patients) with extensive proximal iliofemoral DVT may benefit from thrombolysis, particularly CDT, in which bleeding rates are lower than the systemic thrombolytic therapy [143][144][145][146]. CDT should be considered for patients with symptomatic iliofemoral DVT who have symptoms of less than 14-day duration, good functional status, a life expectancy of 1 year or more and a low risk of bleeding.…”