Efficacy and safety of catheter-directed thrombolysis and anticoagulation for deep vein thrombosis: a meta analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Haoran ,  GAO Yong

The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, P.R.China;

Corresponding?author：

GAO Yong, Email: 767522423@qq.com

Keywords：

Deep vein thrombosis; Catheter-directed thrombolysis; Post-thrombotic Syndrome; RCT; Meta-analysis

DOI：

10.7507/1672-2531.201803057

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectivesTo systematically review the efficacy and safety of catheter-directed thrombolysis (CDT) versus anti-coagulation (AC) for deep vein thrombosis (DVT). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases to collect randomized clinical trials (RCTs) about CDT versus AC for DVT from inception to March 2018. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs and 989 patients were included. Meta-analysis showed that there was no significant difference between the two group in incidence of post-thrombotic syndrome (RR=0.73, 95%CI 0.49 to 1.09, P=0.13), iliofemoral venous patency rate (RR=2.57, 95%CI 0.59 to 11.24, P=0.21), bleeding (RR=2.03, 95%CI 0.50 to 8.28, P=0.32), severe bleeding (RR=1.77, 95%CI 0.91 to 3.42, P=0.09) and recurrence rate of venous thromboembolism (RR=1.00, 95%CI 0.42 to 2.36, P=0.99). However, the incidence of moderate-severe PTS decreased in CDT group was lower than that in the control group (RR=0.70, 95%CI 0.53 to 0.92, P=0.01). ConclusionsCompared with the control group, catheter-directed thrombolysis does not reduce the incidence of PTS and VTE recurrence rate, cannot improve the long-term patency of the iliofemoral vein, yet can prevent the occurrence of moderate to severe PTS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： WANG Haoran, GAO Yong. Efficacy and safety of catheter-directed thrombolysis and anticoagulation for deep vein thrombosis: a meta analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(9): 953-957. doi: 10.7507/1672-2531.201803057 Copy

1.	Vedantham S. Thrombectomy and thrombolysis for the prevention and treatment of post thrombotic syndrome. Hematology Am Soc Hematol Educ Program, 2017, (1): 681-685.
2.	張雄, 楊鏞. 老年人重癥深靜脈血栓形成后綜合征皮膚病變及其治療的研究進展. 中國血管外科雜志 (電子版), 2017, 9(3): 236-240.
3.	Utne KK, Dahm A, Wik HS, et al. Rivaroxaban versus warfarin for the prevention of post-thrombotic syndrome. Thromb Res, 2018, 163: 6-11.
4.	MacDougall DA, Feliu AL, Boccuzzi SJ, et al. Economic burden of deep-vein thrombosis, Pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm, 2006, 63(20 Suppl 6): S5-15.
5.	Bergan JJ, Schmid-Sch?nbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med, 2006, 355(5): 488-498.
6.	Guanella R, Ducruet T, Johri M, et al. Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation. J Thromb Haemost, 2011, 9(12): 2397-2405.
7.	Kahn SR, Shbaklo H, LamPing DL, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost, 2008, 6(7): 1105-1112.
8.	Lubberts B, Paulino Pereira NR, Kabrhel C, et al. What is the effect of venous thromboembolism and related complications on patient reported health-related quality of life? a meta-analysis. Thromb Haemost, 2016, 116(3): 417-431.
9.	Elsharawy M. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis A randomised clinical trial. Eur J Vasc Endovasc Surg, 2002, 24(3): 209-214.
10.	Enden T, Haig Y, Klow NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet, 2012, 379(9810): 31-38.
11.	陸燁. 不同給藥方式在置管溶栓治療下肢深靜脈血栓形成中的療效及安全性比較. 武漢: 華中科技大學, 2014.
12.	Haig Y, Enden T, Grotta O, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol, 2016, 3(2): e64-71.
13.	Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med, 2017, 377(23): 2240-2252.
14.	陳魁, 史吏, 高涌. 下肢深靜脈血栓后綜合征的研究及診療進展. 中華全科醫學, 2012, 10(2): 284-285, 323.
15.	Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev, 2014, (1): cd002827.
16.	Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: chest guideline and expert panel report. Chest, 2016, 149(2): 315-352.
17.	Jiang K, Li XQ, Sang HF, et al. Mid-term outcome of endovascular treatment for acute lower extremity deep venous thrombosis. Phlebology, 2017, 32(3): 200-206.
18.	Berencsi A, Dósa E, Nemes B, et al. Endovascular treatment of acute iliofemoral deep venous thrombosis-our results with catheter-directed thrombolysis and AngioJet. Magy Seb, 2017, 70(1): 24-31.
19.	焦元勇, 章希煒, 鄒君杰, 等. 股靜脈內膜剝脫聯合介入手術在中重度血栓形成后綜合征中的應用. 中華血管外科雜志, 2016, 1(1): 33-36.
20.	Enden T, Klow NE, Sandvik L, et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short-term patency. J Thromb Haemost, 2009, 7(8): 1268-1275.

1. Vedantham S. Thrombectomy and thrombolysis for the prevention and treatment of post thrombotic syndrome. Hematology Am Soc Hematol Educ Program, 2017, (1): 681-685.
2. 張雄, 楊鏞. 老年人重癥深靜脈血栓形成后綜合征皮膚病變及其治療的研究進展. 中國血管外科雜志 (電子版), 2017, 9(3): 236-240.
3. Utne KK, Dahm A, Wik HS, et al. Rivaroxaban versus warfarin for the prevention of post-thrombotic syndrome. Thromb Res, 2018, 163: 6-11.
4. MacDougall DA, Feliu AL, Boccuzzi SJ, et al. Economic burden of deep-vein thrombosis, Pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm, 2006, 63(20 Suppl 6): S5-15.
5. Bergan JJ, Schmid-Sch?nbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med, 2006, 355(5): 488-498.
6. Guanella R, Ducruet T, Johri M, et al. Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation. J Thromb Haemost, 2011, 9(12): 2397-2405.
7. Kahn SR, Shbaklo H, LamPing DL, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost, 2008, 6(7): 1105-1112.
8. Lubberts B, Paulino Pereira NR, Kabrhel C, et al. What is the effect of venous thromboembolism and related complications on patient reported health-related quality of life? a meta-analysis. Thromb Haemost, 2016, 116(3): 417-431.
9. Elsharawy M. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis A randomised clinical trial. Eur J Vasc Endovasc Surg, 2002, 24(3): 209-214.
10. Enden T, Haig Y, Klow NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet, 2012, 379(9810): 31-38.
11. 陸燁. 不同給藥方式在置管溶栓治療下肢深靜脈血栓形成中的療效及安全性比較. 武漢: 華中科技大學, 2014.
12. Haig Y, Enden T, Grotta O, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol, 2016, 3(2): e64-71.
13. Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med, 2017, 377(23): 2240-2252.
14. 陳魁, 史吏, 高涌. 下肢深靜脈血栓后綜合征的研究及診療進展. 中華全科醫學, 2012, 10(2): 284-285, 323.
15. Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev, 2014, (1): cd002827.
16. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: chest guideline and expert panel report. Chest, 2016, 149(2): 315-352.
17. Jiang K, Li XQ, Sang HF, et al. Mid-term outcome of endovascular treatment for acute lower extremity deep venous thrombosis. Phlebology, 2017, 32(3): 200-206.
18. Berencsi A, Dósa E, Nemes B, et al. Endovascular treatment of acute iliofemoral deep venous thrombosis-our results with catheter-directed thrombolysis and AngioJet. Magy Seb, 2017, 70(1): 24-31.
19. 焦元勇, 章希煒, 鄒君杰, 等. 股靜脈內膜剝脫聯合介入手術在中重度血栓形成后綜合征中的應用. 中華血管外科雜志, 2016, 1(1): 33-36.
20. Enden T, Klow NE, Sandvik L, et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short-term patency. J Thromb Haemost, 2009, 7(8): 1268-1275.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of catheter-directed thrombolysis and anticoagulation for deep vein thrombosis: a meta analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content