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Published on: June 2, 2015
Endovascular Management of Acute Lower Limb Deep Vein Thrombosis: A Systematic Review and Meta-analysis
Matthew Thomas1, Andrew Hollingsworth2, Reza Mofidi2
1Department of Vascular Surgery, Freeman Hospital, Newcastle-upon-Tyne, UK.
Insights
Catheter-directed thrombolysis (CDT) effectively reduces post-thrombotic syndrome (PTS) and recurrent venous thromboembolism (VTE) in deep vein thrombosis (DVT) patients. However, CDT increases bleeding complications compared to traditional anticoagulation.
Area of Science:
- Vascular Medicine
- Interventional Cardiology
- Thrombosis Research
Background:
- Deep vein thrombosis (DVT) poses significant risks, including post-thrombotic syndrome (PTS).
- Oral anticoagulation is traditional, but endovascular techniques like catheter-directed thrombolysis (CDT) are emerging.
- Evidence for endovascular methods in acute lower limb DVT and PTS reduction needs review.
Purpose of the Study:
- To systematically review evidence on endovascular techniques for acute lower limb DVT.
- To assess the efficacy of CDT, pharmacomechanical thrombolysis, and venous stenting in reducing PTS.
- To compare endovascular approaches with oral anticoagulation regarding PTS, recurrent VTE, and bleeding.
Main Methods:
- Systematic review and meta-analysis of studies comparing endovascular techniques with oral anticoagulation.
- Primary outcome: incidence of post-thrombotic syndrome (PTS).
- Secondary outcomes: recurrent venous thromboembolism (VTE) and bleeding complications.
Main Results:
- CDT significantly reduced PTS incidence (RR 0.56).
- Pharmacomechanical thrombolysis showed no statistically significant effect on PTS (RR 0.87).
- CDT was associated with increased bleeding complications (RR 5.11) but reduced recurrent VTE (RR 0.62).
Conclusions:
- CDT effectively decreases PTS in iliofemoral DVT but increases bleeding risk.
- Pharmacomechanical thrombolysis is not effective for PTS in DVT.
- Further research is needed for endovascular management below the iliofemoral level and venous stenting.
Background:
Deep vein thrombosis (DVT) is associated with significant complications, including the development of post-thrombotic syndrome (PTS). Traditional management is with oral anticoagulation, but the endovascular techniques of catheter-directed thrombolysis (CDT), pharmacomechanical thrombolysis, and venous stenting are now increasingly used. This study aims to review the evidence for these endovascular techniques in the management of acute lower limb DVT, and their role in the reduction of complications such as PTS.
Methods:
A systematic review and meta-analysis was carried out, with studies that compared CDT, pharmacomechanical thrombolysis, and/or venous stenting with oral anticoagulation included. Primary outcome measure was the incidence of PTS; secondary outcome measures were the incidence of recurrent venous thromboembolism (VTE) and bleeding complications. Treatment effects were calculated as risk ratios (RR) with their 95% confidence interval (CI).
Results:
Five studies met the final inclusion criteria. CDT reduced the incidence of PTS (RR 0.56, 95% CI 0.43-0.73), whereas pharmacomechanical thrombolysis had only a minor effect on the incidence of PTS that did not achieve statistical significance (RR 0.87, 95% CI 0.75-1.01). Recurrent VTE following CDT was reduced compared to oral anticoagulation (RR 0.62, 95% CI 0.34-1.13), while bleeding complications were more likely following CDT (RR 5.11, 95% CI 2.16-12.08).
Conclusions:
CDT decreases the incidence of PTS when treating iliofemoral DVT, but pharmacomechanical thrombolysis does not. CDT also reduces the incidence of recurrent VTE, but leads to more bleeding complications when compared to oral anticoagulation. Further randomized controlled trials are needed to determine the role of endovascular management of DVT occurring below the iliofemoral level, and the role of venous stenting.
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