Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis

Background: The aim of this meta-analysis was to compare the clinical outcomes of catheter-directed thrombolysis (CDT) plus anticoagulation with anticoagulation alone in patients with lower-extremity proximal deep vein thrombosis (DVT). Patients and methods: We systematically searched Pubmed, Embase, and the Cochrane Library from inception to October, 2014. All randomized controlled trials (RCTs) and non-randomized studies comparing the clinical outcomes between additional CDT and anticoagulation alone were included. The primary outcomes were postthrombotic syndrome and major bleeding complications. The secondary outcomes included the iliofemoral patency rate, deep venous function, mortality, pulmonary embolism, and recurrent DVT. Results: Three RCTs and 3 non-randomized studies were included. Compared with standard anticoagulation treatment, additional CDT was associated with a significantly higher rate of complete lysis within 30 days (OR = 91; 95 % CI 19.28 to 429.46), a higher rate of 6-month patency (OR = 5.77; 95 % CI 1.99 to 16.73), a lower rate of postthrombotic syndrome (OR = 0.4; 95 % CI 0.19 to 0.96), and a lower rate of venous obstruction (OR = 0.20; 95 % CI 0.09 to 0.44). More major bleeding episodes occurred in the CDT group (Peto OR 2.0; 95 % CI 1.62 to 2.62). CDT was not found to reduce mortality, pulmonary embolism, or recurrent DVT. Conclusions: Additional CDT therapy appeared to be more effective than standard anticoagulation treatment in improving the venous patency and preventing venous obstruction and postthrombotic syndrome. Caution should be taken when performing CDT given the increased risk of major bleeding. However, no evidence supported benefits of CDT in reducing mortality, recurrent DVT, or pulmonary embolism.

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Catheter-Directed Thrombolysis Versus Standard Anticoagulation for Acute Lower Extremity Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029617739703 ◽

2017 ◽

Vol 24 (7) ◽

pp. 1134-1143 ◽

Cited By ~ 12

Author(s):

Yongming Lu ◽

Linyi Chen ◽

Jinhui Chen ◽

Tao Tang

Keyword(s):

Deep Vein Thrombosis ◽

Lower Extremity ◽

Meta Analysis ◽

Anticoagulation Therapy ◽

Postthrombotic Syndrome ◽

Bleeding Events ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Significant Difference ◽

Deep Vein

Standard anticoagulant treatment alone for acute lower extremity deep vein thrombosis (DVT) is ineffective in eliminating thrombus from the deep venous system, with many patients developing postthrombotic syndrome (PTS). Because catheter-directed thrombolysis (CDT) can dissolve the clot, reducing the development of PTS in iliofemoral or femoropopliteal DVT. This meta-analysis compares CDT plus anticoagulation versus standard anticoagulation for acute iliofemoral or femoropopliteal DVT. Ten trials were included in the meta-analysis. Compared with anticoagulant alone, CDT was shown to significantly increase the percentage patency of the iliofemoral vein ( P < .00001; I2 = 44%) and reduce the risk of PTS ( P = .0002; I2 = 79%). In subgroup analysis of randomized controlled trials, CDT was not shown to prevent PTS ( P = .2; I2 = 59%). A reduced PTS risk was shown, however, in nonrandomized trials ( P < .00001; I2 = 47%). Meta-analysis showed that CDT can reduce severe PTS risk ( P = .002; I2 = 0%). However, CDT was not indicated to prevent mild PTS ( P = .91; I2 = 79%). A significant increase in bleeding events ( P < .00001; I2 = 33%) and pulmonary embolism (PE) ( P < .00001; I2 = 14%) were also demonstrated. However, for the CDT group, the duration of stay in the hospital was significantly prolonged compared to the anticoagulant group ( P < .00001; I2 = 0%). There was no significant difference in death ( P = .09; I2 = 0%) or recurrent venous thromboembolism events ( P = .52; I2 = 58%). This meta-analysis showed that CDT may improve patency of the iliofemoral vein or severe PTS compared with anticoagulation therapy alone, but measuring PTS risk remains controversial. However, CDT could increase the risk of bleeding events, PE events, and duration of hospital stay.

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Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis – a systematic review and meta-analysis

VASA ◽

10.1024/0301-1526/a000875 ◽

2021 ◽

Vol 50 (1) ◽

pp. 59-67

Author(s):

Michael K. W. Lichtenberg ◽

Stefan Stahlhoff ◽

Katarzyna Młyńczak ◽

Dominik Golicki ◽

Paul Gagne ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Major Bleeding ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Primary Patency ◽

Percutaneous Mechanical Thrombectomy ◽

Vein Thrombosis ◽

Deep Vein ◽

Endovascular Mechanical Thrombectomy

Summary: Background: This study sought to compare effectiveness and safety of percutaneous mechanical thrombectomy (PMT) and thrombolysis alone (THR) in patients with acute or subacute iliofemoral deep vein thrombosis (IfDVT). Patients and methods: Observational and randomized trials, published between January 2001 to February 2019 were identified by searching MEDLINE. Studies on deep venous thrombosis (DVT) treated with either THR or PMT adjunctive to conventional anticoagulation and compressive intervention were included. Meta-analysis of proportions was conducted to assess effectiveness outcomes of successful lysis and primary patency, post-thrombotic syndrome (PTS), valvular reflux, recurrent DVT, as well as safety outcomes of major bleeding, hematuria, and pulmonary embolism. Results: Of 77 identified records, 17 studies including 1417 patients were eligible. Pooled proportion of successful lysis was similar between groups (THR: 95 % [I2 = 68.4 %], PMT 96 %, [I2 = 0 %]; Qbet [Cochran’s Q between groups] 0.3, p = 0.61). However, pooled proportion of 6-month primary patency was lower after THR than after PMT (68 % [I2 = 15.6 %] versus 94 %; Qbet 26.4, p < 0.001). Considerable heterogeneity within groups did not allow for between-group comparison of PTS and recurrent DVT. Major bleeding was more frequent after THR than after PMT (6.0 % [I2 = 0 %] versus 1.0 % [I2 = 0 %]; Qbet 12.3, p < 0.001). Incidence of hematuria was lower after THR as compared to PMT (2 % [I2 = 56 %] versus 91.3 % [I2 = 91.7 %]; Qbet 714, p < 0.001). Incidences of valvular reflux and pulmonary embolism were similar across groups (THR: 61 % versus PMT: 53 %; Qbet 0.7, p = 0.39 and THR: 2 % versus PMT: 1 %; Qbet 1.1, p = 0.30, respectively). Conclusions: In patients with iliofemoral DVT, percutaneous mechanical thrombectomy was associated with a higher cumulative 6-month primary patency and a lower incidence of major bleeding compared to thrombolysis alone. Risk of hemolysis from mechanical thrombectomy needs further consideration.

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Faculty Opinions recommendation of The incidence of pulmonary embolism and deep vein thrombosis after knee arthroplasty in Asians remains low: a meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717969742.793471138 ◽

2013 ◽

Author(s):

Mark Alberts

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Vein Thrombosis ◽

Deep Vein

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Faculty Opinions recommendation of Rationale and design of the ATTRACT Study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717995541.793475244 ◽

2013 ◽

Author(s):

David Varon

Keyword(s):

Deep Vein Thrombosis ◽

Randomized Trial ◽

Proximal Deep Vein Thrombosis ◽

Postthrombotic Syndrome ◽

Vein Thrombosis ◽

Multicenter Randomized Trial ◽

Catheter Directed Thrombolysis ◽

Deep Vein

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Should Patients with Deep Vein Thrombosis Alone be Treated as Those with Concomitant Asymptomatic Pulmonary Embolism? A Prospective Study

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613337 ◽

2002 ◽

Vol 88 (12) ◽

pp. 938-942 ◽

Cited By ~ 15

Author(s):

Harry Büller ◽

Anthonie Lensing ◽

Montserrat Bonet ◽

Javier Roncales ◽

Jordi Muchart ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Major Bleeding ◽

Odds Ratio ◽

Vitamin K Antagonists ◽

Fixed Dose ◽

Once Daily ◽

Bleeding Rate ◽

Vein Thrombosis ◽

Deep Vein

SummaryThe established initial treatment of patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) consists of the administration of subcutaneous, weight adjusted, low-molecular weight heparin (LMWH). However, the use of the same LMWH dosages for patients with either DVT or PE is not supported by data from comparative studies.1,000 consecutive patients with acute, proximal DVT were prospectively evaluated. All patients underwent a ventilation-perfusion lung scan on admission, and remained in hospital for at least 7 days. Patients with silent PE received once daily 10,000 to 15,000 IU subcutaneous LMWH dalteparin according to body weight for 7 days, and then vitamin K antagonists. Patients with DVT alone received LMWH in a fixed dose of 10,000 IU once daily for at least 5 days, and then vitamin K antagonists. The rate of both, major bleeding and symptomatic PE episodes during the 7-day study period was evaluated.Thirteen patients (1.3%) developed recurrent PE (1 died) and 16 patients (1.6%) had major bleeding (7 died). Recurrent PE was significantly more common in patients with silent PE (9 of 258 patients, 3.5%) than in those with DVT alone (4 of 742 patients, 0.5%. Odds ratio: 6.5; p <0.001). There were no significant differences in bleeding rate between patients with silent PE and those with DVT alone. However, the use of a fixed 10,000 IU dose in patients with DVT alone led to a significantly lower bleeding rate in patients weighing over 70 kg: 1 of 349 patients (0.3%) as compared to 9 of 393 patients (2.3%) in those weighing less than 70 kg (odds ratio: 0.12; p = 0.018).Fixed-dose 10,000 IU of LMWH dalteparin once daily proved to be both effective and safe in patients with DVT alone. The observed recurrence rate of 0.5% in these patients compares favourably with the 3.5% rate in patients with silent PE. Furthermore, this fixed-dosage was also safe. Patients weighing over 70 kg had a significant decrease in the rate of major bleeding, and no compensatory increase in the rate of recurrent PE.

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Catheter-directed thrombolysis in deep vein thrombosis: Which procedural measurement predicts outcome?

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514529394 ◽

2014 ◽

Vol 29 (1_suppl) ◽

pp. 135-139 ◽

Cited By ~ 3

Author(s):

J Grommes ◽

KT von Trotha ◽

MA de Wolf ◽

H Jalaie ◽

CHA Wittens

Keyword(s):

Deep Vein Thrombosis ◽

Venous Obstruction ◽

Deep Venous System ◽

Vein Thrombosis ◽

Risk Of Bleeding ◽

Catheter Directed Thrombolysis ◽

Increased Risk ◽

Deep Vein ◽

Procedural Outcome

The post-thrombotic syndrome (PTS) as a long-term consequence of deep vein thrombosis (DVT) is caused by a venous obstruction and/or chronic insufficiency of the deep venous system. New endovascular therapies enable early recanalization of the deep veins aiming reduced incidence and severity of PTS. Extended CDT is associated with an increased risk of bleeding and stenting of residual venous obstruction is indispensable to avoid early rethrombosis. Therefore, this article focuses on measurements during or after thrombolysis indicating post procedural outcome.

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Evaluation of the incidence of bleeding in patients prescribed rivaroxaban for the treatment and prevention of deep vein thrombosis and pulmonary embolism in UK secondary care: an observational cohort study

BMJ Open ◽

10.1136/bmjopen-2020-038102 ◽

2020 ◽

Vol 10 (11) ◽

pp. e038102

Author(s):

Alison Evans ◽

Miranda Davies ◽

Vicki Osborne ◽

Debabrata Roy ◽

Saad Shakir

Keyword(s):

Pulmonary Embolism ◽

Cohort Study ◽

Deep Vein Thrombosis ◽

Major Bleeding ◽

Secondary Care ◽

Observational Cohort Study ◽

Vein Thrombosis ◽

Prevention And Treatment ◽

Observational Cohort ◽

Deep Vein

ObjectivesTo evaluate the short-term (12 weeks) safety and utilisation of rivaroxaban prescribed to new-user adult patients for the treatment of deep vein thrombosis and pulmonary embolism and for the prevention of recurrent deep vein thrombosis and pulmonary embolism in a secondary care setting in England and Wales.DesignAn observational cohort study using the technique of Specialist Cohort Event Monitoring.SettingThe Rivaroxaban Observational Safety Evaluation study was conducted across 87 participating National Health Service secondary care trusts in England and Wales.Participants1532 patients treated with rivaroxaban for the prevention and treatment of deep vein thrombosis/pulmonary embolism from September 2013 to January 2016.InterventionsNon-interventional postauthorisation safety study of rivaroxaban.Primary and secondary outcome measures(1) Risk of major bleeding in gastrointestinal, intracranial, and urogenital sites and (2) risk of all major and clinically relevant non-major bleeds.ResultsOf a total of 4846 patients enrolled in the study from September 2013 to January 2016, 1532 were treated with rivaroxaban for the prevention and treatment of deep vein thrombosis/pulmonary embolism. The median age of the deep vein thrombosis/pulmonary embolism cohort was 63 years, and 54.6% were men. The risk of major bleeding within the gastrointestinal, urogenital and intracranial primary sites was 0.7% (n=11), 0.3% (n=5) and 0.1% (n=1), respectively. The risk of major bleeding in all sites was 1.5% (n=23) at a rate of 8.3 events per 100 patient-years.ConclusionsIn terms of the primary outcome risk of major bleeding in gastrointestinal, intracranial and urogenital sites, the risk estimates in the population using rivaroxaban for deep vein thrombosis/pulmonary embolism were low (<1%) and consistent with the risk estimated from clinical trial data and in routine clinical practice.Trial registration numbersClinicalTrials.gov Registry (NCT01871194); ENCePP Registry (EUPAS3979).

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Prophylactic anticoagulant therapy decreases the incidence of deep vein thrombosis in patients with solid tumors: A systematic review and meta-analysis

Journal of Solid Tumors ◽

10.5430/jst.v7n1p35 ◽

2017 ◽

Vol 7 (1) ◽

pp. 35

Author(s):

Yunjiao Zhou ◽

Gong Yang ◽

Chenglei Huang

Keyword(s):

Systematic Review ◽

Deep Vein Thrombosis ◽

Solid Tumors ◽

Risk Ratio ◽

Major Bleeding ◽

Meta Analysis ◽

Bleeding Events ◽

Vein Thrombosis ◽

And Control ◽

Deep Vein

It is not well understood the efficacy and safety of primary deep vein thrombosis (DVT) prophylaxis of anticoagulants in patients with solid tumors. This systematic review and meta-analysis of randomized controlled trials (RCT) determines the relative ratio of primary DVT, survival rate and bleeding events among patients with solid tumors treated with anticoagulants or placebo. Comprehensive literature searches were conducted through the Pubmed, Ovid MEDLINE and EMBASE databases published from January 1st, 1993 to December 31st, 2015. Statistical analysis was performed by RevMan 5.0 software. For DVT events, therisk ratio in 16 trials between the prophylactic and control patients was statistically significant at 0.45 [0.36-0.58]; for major bleeding events, the risk ratio in 18 trials between the prophylactic and control patients was not statistically significant at 1.33 [0.99-1.79], while that in 15 trials with clinically relevant non-major bleeding was statistically significant at 1.83 [1.46-2.30]; the risk ratio for the mortality rate of patients with solid tumors in 16 trials was not statistically significant at 0.97 [0.93-1.02]. Inconclusion, the risk ratio in this meta-analysis showed a significantly reduced incidence of DVT with anticoagulant use. Treatment to patients who had solid tumors with prophylactic anticoagulants enhanced the incidence rate of non-major bleeding but has no significant impact on the incidence rate of major bleeding. No significant differences were found in the mortality outcomes between anticoagulant and non-anticoagulant groups.

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