Catheter-Directed Thrombolysis Protocols for Deep Venous Thrombosis of the Lower Extremities-A Systematic Review and Meta-analysis.
Thromb Haemost
; 124(2): 89-104, 2024 Feb.
Article
in En
| MEDLINE
| ID: mdl-37279794
ABSTRACT
OBJECTIVE:
To summarize characteristics, complications, and success rates of different catheter-directed thrombolysis (CDT) protocols for the treatment of lower extremity deep venous thrombosis (LE-DVT).METHODS:
A systematic review using electronic databases (MEDLINE, Scopus, and Web of Science) was performed to identify randomized controlled trials and observational studies related to LE-DVT treated with CDT. A random-effects model meta-analysis was performed to obtain the pooled proportions of early complications, postthrombotic syndrome (PTS), and venous patency.RESULTS:
Forty-six studies met the inclusion criteria reporting 49 protocols (n = 3,028 participants). In studies that addressed the thrombus location (n = 37), LE-DVT had iliofemoral involvement in 90 ± 23% of the cases. Only four series described CDT as the sole intervention for LE-DVT, while 47% received additional thrombectomy (manual, surgical, aspiration, or pharmacomechanical), and 89% used stenting.Definition of venogram success was highly variable, being the Venous Registry Index the most used method (n = 19). Among those, the minimal thrombolysis rate (<50% lysed thrombus) was 0 to 53%, partial thrombolysis (50-90% lysis) was 10 to 71%, and complete thrombolysis (90-100%) was 0 to 88%. Pooled outcomes were 8.7% (95% confidence interval [CI] 6.6-10.7) for minor bleeding, 1.2% (95% CI 0.8-1.7%) for major bleeding, 1.1% (95% CI 0.6-1.6) for pulmonary embolism, and 0.6% (95% CI 0.3-0.9) for death. Pooled incidences of PTS and of venous patency at up to 1 year of follow-up were 17.6% (95% CI 11.8-23.4) and 77.5% (95% CI 68.1-86.9), respectively.CONCLUSION:
Assessment of the evidence is hampered by the heterogeneity of protocols, which may be reflected in the variation of PTS rates. Despite this, CDT is a low-risk treatment for LE-DVT.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Postphlebitic Syndrome
/
Venous Thrombosis
/
Postthrombotic Syndrome
Type of study:
Clinical_trials
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
Thromb Haemost
Year:
2024
Document type:
Article
Affiliation country:
Portugal
Publication country:
ALEMANHA
/
ALEMANIA
/
DE
/
DEUSTCHLAND
/
GERMANY