Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb

Abstract

BackgroundStandard treatment for deep vein thrombosis (DVT) aims to reduce immediate complications. Use of thrombolytic clot removal strategies (i.e., thrombolysis (clot dissolving drugs) with or without additional endovascular techniques), 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 fourth update of the review first published in 2004.

Antithrombotic Therapy for VTE Disease

“…Study synthesis was drawn from the Broderick et al41 (2021) meta-analysis, except for early bleeding (1-to 30-day follow-up), which includes results of Vedantham et al 42(2017) (see Fig 1). Additional data on breakdown of VTE between PE and DVT not included in the original publication were provided by original study author via communication dated June 15, 2020.…”

Interim outcomes of mechanical thrombectomy for deep vein thrombosis from the All-Comer CLOUT Registry

“…6 Unfortunately, interventions utilizing catheter-directed thrombolysis for DVT treatment have shown mixed efficacy in reducing long-term PTS rates and introduce a significant bleeding risk. 6,[10][11][12][13] There continues to be high clinical interest to identify therapies and devices that can successfully and safely remove thrombus without the use of thrombolytics.…”

“…The Villalta score assesses five patient symptoms and six physician-assessed clinical signs, each on a scale of 0-3, for a final combined score range of 0-33. PTS was defined as a Villalta score greater than 4, and PTS severity was categorized based on Villalta scores as mild (5-9), moderate (10)(11)(12)(13)(14), or severe (> 14). 15 Immediate and sustained symptom relief was captured via pain and edema measurements at baseline, discharge, 30 days, and 6 months.…”

“…J o u r n a l P r e -p r o o f 13 Marder scores from the core laboratory were available for 241 treated limbs in 233 patients. The primary effectiveness endpoint of complete or near-complete (≥75%) thrombus removal was achieved in 85.8% of treated limbs.…”

“…The purely mechanical mechanism of action of the ClotTriever System along with the absence of thrombolytics in any patient contributed to the overall safety of the procedure by eliminating the associated bleeding risks and potential for acute renal injuries. 13,24 In addition, the mechanism of action of the ClotTriever System enabled the removal of thrombus with a negligible amount of blood loss during the procedure. ICU stays were prevented in the vast majority of patients, due to the avoidance of thrombolytics, which require close monitoring as standard of care.…”