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Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis
Lindsay Robertson1, Olivia McBride, Anne Burdess
1Department of Vascular Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne, UK, NE7 7DN.
Insights
This review found no randomized controlled trials on pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis (DVT). More high-quality research is needed to evaluate this DVT treatment.
Area of Science:
- Vascular Medicine
- Interventional Cardiology
- Thrombosis Management
Background:
- Deep venous thrombosis (DVT) affects approximately one in 1000 adults annually, with a 14.6% mortality rate.
- Iliofemoral DVT can lead to severe complications like post-thrombotic syndrome (PTS), causing chronic venous insufficiency, pain, and disability.
- Early intervention, such as pharmacomechanical thrombectomy, is considered to improve vein patency and prevent long-term DVT sequelae.
Purpose of the Study:
- To evaluate the effectiveness of pharmacomechanical thrombectomy compared to other treatments for acute iliofemoral deep vein thrombosis.
- To assess outcomes including anticoagulation, mechanical thrombectomy, thrombolysis, and other endovascular techniques.
Main Methods:
- A systematic search of specialized databases (Cochrane Vascular, Register of Studies) was conducted up to December 2015.
- Inclusion criteria focused on randomized controlled trials comparing pharmacomechanical thrombectomy with alternative iliofemoral DVT treatments.
- Study selection and data extraction were performed independently by at least two review authors.
Main Results:
- No randomized controlled trials meeting the eligibility criteria were identified for this review.
- One ongoing study relevant to the research question was noted.
Conclusions:
- There is a lack of high-quality randomized controlled trials evaluating pharmacomechanical thrombectomy for acute iliofemoral DVT.
- Further rigorous research is essential to establish the efficacy and safety of this interventional approach compared to standard treatments.
Background:
Deep venous thrombosis (DVT) occurs in approximately one in 1000 adults every year, and has an annual mortality of 14.6%. In particular, iliofemoral DVT can lead to recurrent thrombosis and post-thrombotic syndrome (PTS), a painful condition which can lead to chronic venous insufficiency, oedema, and ulceration. It causes significant disability, impaired quality of life, and economic burden. Early thrombus removal techniques have been advocated in patients with an iliofemoral DVT in order to improve vein patency, prevent valvular dysfunction, and reduce future complications, such as post-thrombotic syndrome and venous ulceration. One such technique is pharmacomechanical thrombectomy, a combination of catheter-based thrombectomy and catheter-directed thrombolysis.
Objectives:
To assess the effects of pharmacomechanical thrombectomy versus anticoagulation (alone or with compression stockings), mechanical thrombectomy, thrombolysis, or other endovascular techniques in the management of people with acute DVT of the iliofemoral vein.
Search Methods:
The Cochrane Vascular Information Specialist searched the Specialised Register (last searched December 2015) and the Cochrane Register of Studies (last searched December 2015). We searched clinical trials databases for details of ongoing or unpublished studies and the reference lists of relevant articles retrieved by electronic searches for additional citations.
Selection Criteria:
Randomised controlled trials in which patients with an iliofemoral deep vein thrombosis were allocated to receive pharmacomechanical thrombectomy versus anticoagulation, mechanical thrombectomy, thrombolysis (systemic or catheter directed thrombolysis), or other endovascular techniques for the treatment of iliofemoral DVT.
Data Collection And Analysis:
At least two review authors independently assessed studies identified for potential inclusion.
Main Results:
We found no randomised controlled trials that met the eligibility criteria for this review. We identified one ongoing study.
Authors' Conclusions:
There were no randomised controlled trials that assessed the effects of pharmacomechanical thrombectomy versus anticoagulation (alone or with compression stockings), mechanical thrombectomy, thrombolysis, or other endovascular techniques in the management of people with acute DVT of the iliofemoral vein that met the eligibility criteria for this review. Further high quality randomised controlled trials are needed.
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