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

• Type: Another Publication in an International Scientific Journal
• Date: 2024

Authors

Duarte Gamas, L (Author) Other; Jácome, F (Author) Other; Dias, LR (Author) Other; Rocha Neves, J (Author) FMUP; Yeung, KK (Author) Other; Baekgaard, N (Author) Other; Dias-Neto M (Author) FMUP

Journal

Title: Thrombosis and Haemostasis

Vol. 124

Pages: 89-104

ISSN: 0340-6245

Publisher: Thieme

Indexing

ISI Web of Knowledge - 6 Citations

Scopus - 7 Citations

Other information

Authenticus ID: P-00Y-R2M

DOI: 10.1055/a-2106-3754

Abstract (EN): 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, andWeb 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.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 16