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.
ObjectiveTo compare the differences of incidence rate and severity of postthrombotic syndrome (PTS) of patients with lower extremity deep venous thrombosis (DVT) treated by catherter-directed thrombolysis (CDT) or via peripheral vein thrombolysis (PVT).MethodsThe patients with unilateral lower extremity DVT who had received anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2015 were collected. These patients were divided into CDT group and PVT group according to the different thrombolysis methods, and then the thrombolytic rates, thrombolytic complications, and the incidence rate and severity of PTS of 5-year follow up results were calculated and compared.ResultsA total of 137 cases of DVT were collected, 79 in the CDT group and 58 in the PVT group. There were no significant differences in the gender, age, course of disease, thrombus type, and other baseline data between the two groups (P>0.05). The thrombolytic rate of the CDT group was (78.6±16.3)% and PVT group was (27.3±12.1)%, the difference was significant (t=21.14, P<0.001). The rate of thrombolytic complications between the PVT group and CDT group had no statistical significance (32.8% versus 21.5%, χ2=2.18, P=0.134). The 5-year follow up was completed in 116 cases, 74 patients from the CDT group and 42 patients from the PVT group respectively, the result showed that the incidence rate of the PTS in the CDT group was lower than that in the PVT group (35.1% versus 88.1%, χ2=30.28, P<0.001), and theseverity of PTS in the CDT group was milder than that in the PVT group too (Z=16.52,P<0.001).ConclusionFrom the results of this study, CDT is able to increase thrombolytic rate and effectively reduce incidence rate and severity of PTS.
ObjectiveTo compare the effect of catheter-directed thrombolysis (CDT) combined with anticoagulation (AC) and AC in the treatment of acute proximal deep venous thrombosis (APDVT) of the lower extremities. MethodsThe clinical data of 184 APDVT patients treated in Guizhou Provincial People’s Hospital from January 2017 to December 2022 were retrospectively collected. According to the treatment methods, the patients were divided into CDT group (n=82, CDT combined with AC) and AC group (n=102, AC alone). The prognosis indicators such as the incidence of bleeding events, the incidence of post-thrombotic syndrome (PTS), Villalta score, venous clinical severity score (VCSS) and chronic lower limb venous insufficiency questionnaire (CIVIQ) score were compared between the two groups. ResultsCompared with the AC group, the CDT group had a higher incidence of bleeding events [11.0% (9/82) vs. 2.9% (3/102)], a shorter time to detumescent [(2.8±1.2) d vs. (7.2±1.9) d], and lower VS score [3 (2,4) vs. 3 (2, 7)], VCSS score [2.0 (1.7, 4.0) vs. 3.0 (2.0, 5.2)] and postoperative venous patency score [1 (1, 2) vs. 2 (1, 3)], and higher CIVIQ score [80.0 (77.0, 86.0) vs. 71.5 (68.0, 78.0)], P<0.05. However, there were no significant differences in the incidence of PTS [28.2% (22/78) vs. 36.5% (35/96)] and thrombosis recurrence rate [9.0% (7/78) vs. 11.5% (11/96)] between the two groups (P>0.05). ConclusionCDT can relieve the symptoms and improve the quality of life of APDVT faster than AC, but it is necessary to strictly grasp the indications of thrombolysis to reduce the risk of bleeding.