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

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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.	张雄, 杨镛. 老年人重症深静脉血栓形成后综合征皮肤病变及其治疗的研究进展. 中国血管外科杂志 (电子版), 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-Schönbein 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.	陆烨. 不同给药方式在置管溶栓治疗下肢深静脉血栓形成中的疗效及安全性比较. 武汉: 华中科技大学, 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.	陈魁, 史吏, 高涌. 下肢深静脉血栓后综合征的研究及诊疗进展. 中华全科医学, 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, 章希炜, 邹君杰, 等. 股静脉内膜剥脱联合介入手术在中重度血栓形成后综合征中的应用. 中华血管外科杂志, 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. 张雄, 杨镛. 老年人重症深静脉血栓形成后综合征皮肤病变及其治疗的研究进展. 中国血管外科杂志 (电子版), 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-Schönbein 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. 陆烨. 不同给药方式在置管溶栓治疗下肢深静脉血栓形成中的疗效及安全性比较. 武汉: 华中科技大学, 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. 陈魁, 史吏, 高涌. 下肢深静脉血栓后综合征的研究及诊疗进展. 中华全科医学, 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, 章希炜, 邹君杰, 等. 股静脉内膜剥脱联合介入手术在中重度血栓形成后综合征中的应用. 中华血管外科杂志, 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

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