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Thromb Haemost 2024; 124(02): 089-104
DOI: 10.1055/a-2106-3754
Coagulation and Fibrinolysis

Catheter-Directed Thrombolysis Protocols for Deep Venous Thrombosis of the Lower Extremities—A Systematic Review and Meta-analysis

Luís Duarte-Gamas
1   Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
2   Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
,
Filipa Jácome
1   Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
2   Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
,
Lara Romana Dias
1   Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
2   Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
,
João Rocha-Neves
1   Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
3   Biomedicine Department - Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal
,
Kak K. Yeung
4   Department of Vascular Surgery, Amsterdam University Medical Centres, location VUmc, Amsterdam, The Netherlands
5   Department of Physiology, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
,
Niels Baekgaard
6   Department of Vascular Surgery, Rigshospitalet and Gentofte Hospital, Copenhagen, Denmark
,
Marina Dias-Neto
1   Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
2   Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Comment on:

Catheter-Directed Thrombolysis for Deep Vein Thrombosis: Serving at Break PointThromb Haemost 2024; 124(02): 105-107
DOI: 10.1055/s-0043-1776009

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.

Keywords

deep venous thrombosis - thrombolysis - protocols - systematic review - meta-analysis

Supplementary Material



Publication History

Received: 18 December 2022

Accepted: 02 June 2023

Accepted Manuscript online:
06 June 2023

Article published online:
24 July 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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