Catheter-directed thrombolysis vs. anticoagulation for the prevention and treatment of post-thrombotic syndrome in deep vein thrombosis

An updated systematic review and meta-analysis of randomized trials

Ioannis Mastoris, Damianos G. Kokkinidis, Iosif Bikakis, Paraschos Archontakis-Barakakis, Christos A. Papanastasiou, Anil Kumar Jonnalagadda, Dimitrios Schizas, Christos Bakoyiannis, Leonidas Palaiodimos, Robert T. Faillace

Research output: Contribution to journalArticle

Abstract

Background: Oral anticoagulation therapy was the mainstay of deep vein thrombosis treatment but recently, catheter-directed thrombolysis has emerged as an alternative. Objective: To compare the efficacy and safety of the two strategies. Methods: Medline, Embase and Cochrane CENTRAL were reviewed. Outcomes of interest included post-thrombotic syndrome, thromboembolic events, mortality, bleeding risk and iliofemoral patency. A random effects model meta-analysis was performed. Heterogeneity was assessed with I square. Results: Four randomized controlled trials (RCTs) including 1005 patients met the inclusion criteria. Catheter-directed thrombolysis was more likely to prevent overall post-thrombotic syndrome compared to anticoagulation only (OR: 0.32; 95% CI: 0.12–0.85; I 2 =87.2%), and to lead to iliofemoral vein patency (OR: 2.7; 95% CI: 1.08–6.75; I 2 =55.3%) but no difference was noted in thromboembolic events (OR = 0.5; 95% CI: 0.08–3.02, I 2 =55.1%), bleeding and mortality rates. Conclusions: Catheter-directed thrombolysis can decrease post-thrombotic syndrome rates and improve iliofemoral vein patency compared to anticoagulation when used for the treatment of deep vein thrombosis.

Original languageEnglish (US)
JournalPhlebology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Venous Thrombosis
Meta-Analysis
Catheters
Veins
Hemorrhage
Mortality
Therapeutics
Randomized Controlled Trials
Safety

Keywords

  • catheter-directed thrombolysis
  • Deep vein thrombosis
  • post-thrombotic syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Catheter-directed thrombolysis vs. anticoagulation for the prevention and treatment of post-thrombotic syndrome in deep vein thrombosis : An updated systematic review and meta-analysis of randomized trials. / Mastoris, Ioannis; Kokkinidis, Damianos G.; Bikakis, Iosif; Archontakis-Barakakis, Paraschos; Papanastasiou, Christos A.; Jonnalagadda, Anil Kumar; Schizas, Dimitrios; Bakoyiannis, Christos; Palaiodimos, Leonidas; Faillace, Robert T.

In: Phlebology, 01.01.2019.

Research output: Contribution to journalArticle

Mastoris, Ioannis ; Kokkinidis, Damianos G. ; Bikakis, Iosif ; Archontakis-Barakakis, Paraschos ; Papanastasiou, Christos A. ; Jonnalagadda, Anil Kumar ; Schizas, Dimitrios ; Bakoyiannis, Christos ; Palaiodimos, Leonidas ; Faillace, Robert T. / Catheter-directed thrombolysis vs. anticoagulation for the prevention and treatment of post-thrombotic syndrome in deep vein thrombosis : An updated systematic review and meta-analysis of randomized trials. In: Phlebology. 2019.
@article{06a8f3ba6b404191b3faca8d781b34e7,
title = "Catheter-directed thrombolysis vs. anticoagulation for the prevention and treatment of post-thrombotic syndrome in deep vein thrombosis: An updated systematic review and meta-analysis of randomized trials",
abstract = "Background: Oral anticoagulation therapy was the mainstay of deep vein thrombosis treatment but recently, catheter-directed thrombolysis has emerged as an alternative. Objective: To compare the efficacy and safety of the two strategies. Methods: Medline, Embase and Cochrane CENTRAL were reviewed. Outcomes of interest included post-thrombotic syndrome, thromboembolic events, mortality, bleeding risk and iliofemoral patency. A random effects model meta-analysis was performed. Heterogeneity was assessed with I square. Results: Four randomized controlled trials (RCTs) including 1005 patients met the inclusion criteria. Catheter-directed thrombolysis was more likely to prevent overall post-thrombotic syndrome compared to anticoagulation only (OR: 0.32; 95{\%} CI: 0.12–0.85; I 2 =87.2{\%}), and to lead to iliofemoral vein patency (OR: 2.7; 95{\%} CI: 1.08–6.75; I 2 =55.3{\%}) but no difference was noted in thromboembolic events (OR = 0.5; 95{\%} CI: 0.08–3.02, I 2 =55.1{\%}), bleeding and mortality rates. Conclusions: Catheter-directed thrombolysis can decrease post-thrombotic syndrome rates and improve iliofemoral vein patency compared to anticoagulation when used for the treatment of deep vein thrombosis.",
keywords = "catheter-directed thrombolysis, Deep vein thrombosis, post-thrombotic syndrome",
author = "Ioannis Mastoris and Kokkinidis, {Damianos G.} and Iosif Bikakis and Paraschos Archontakis-Barakakis and Papanastasiou, {Christos A.} and Jonnalagadda, {Anil Kumar} and Dimitrios Schizas and Christos Bakoyiannis and Leonidas Palaiodimos and Faillace, {Robert T.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/0268355519835618",
language = "English (US)",
journal = "Phlebology",
issn = "1433-3031",
publisher = "SAGE Publications Ltd",

}

TY - JOUR

T1 - Catheter-directed thrombolysis vs. anticoagulation for the prevention and treatment of post-thrombotic syndrome in deep vein thrombosis

T2 - An updated systematic review and meta-analysis of randomized trials

AU - Mastoris, Ioannis

AU - Kokkinidis, Damianos G.

AU - Bikakis, Iosif

AU - Archontakis-Barakakis, Paraschos

AU - Papanastasiou, Christos A.

AU - Jonnalagadda, Anil Kumar

AU - Schizas, Dimitrios

AU - Bakoyiannis, Christos

AU - Palaiodimos, Leonidas

AU - Faillace, Robert T.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Oral anticoagulation therapy was the mainstay of deep vein thrombosis treatment but recently, catheter-directed thrombolysis has emerged as an alternative. Objective: To compare the efficacy and safety of the two strategies. Methods: Medline, Embase and Cochrane CENTRAL were reviewed. Outcomes of interest included post-thrombotic syndrome, thromboembolic events, mortality, bleeding risk and iliofemoral patency. A random effects model meta-analysis was performed. Heterogeneity was assessed with I square. Results: Four randomized controlled trials (RCTs) including 1005 patients met the inclusion criteria. Catheter-directed thrombolysis was more likely to prevent overall post-thrombotic syndrome compared to anticoagulation only (OR: 0.32; 95% CI: 0.12–0.85; I 2 =87.2%), and to lead to iliofemoral vein patency (OR: 2.7; 95% CI: 1.08–6.75; I 2 =55.3%) but no difference was noted in thromboembolic events (OR = 0.5; 95% CI: 0.08–3.02, I 2 =55.1%), bleeding and mortality rates. Conclusions: Catheter-directed thrombolysis can decrease post-thrombotic syndrome rates and improve iliofemoral vein patency compared to anticoagulation when used for the treatment of deep vein thrombosis.

AB - Background: Oral anticoagulation therapy was the mainstay of deep vein thrombosis treatment but recently, catheter-directed thrombolysis has emerged as an alternative. Objective: To compare the efficacy and safety of the two strategies. Methods: Medline, Embase and Cochrane CENTRAL were reviewed. Outcomes of interest included post-thrombotic syndrome, thromboembolic events, mortality, bleeding risk and iliofemoral patency. A random effects model meta-analysis was performed. Heterogeneity was assessed with I square. Results: Four randomized controlled trials (RCTs) including 1005 patients met the inclusion criteria. Catheter-directed thrombolysis was more likely to prevent overall post-thrombotic syndrome compared to anticoagulation only (OR: 0.32; 95% CI: 0.12–0.85; I 2 =87.2%), and to lead to iliofemoral vein patency (OR: 2.7; 95% CI: 1.08–6.75; I 2 =55.3%) but no difference was noted in thromboembolic events (OR = 0.5; 95% CI: 0.08–3.02, I 2 =55.1%), bleeding and mortality rates. Conclusions: Catheter-directed thrombolysis can decrease post-thrombotic syndrome rates and improve iliofemoral vein patency compared to anticoagulation when used for the treatment of deep vein thrombosis.

KW - catheter-directed thrombolysis

KW - Deep vein thrombosis

KW - post-thrombotic syndrome

UR - http://www.scopus.com/inward/record.url?scp=85063046219&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063046219&partnerID=8YFLogxK

U2 - 10.1177/0268355519835618

DO - 10.1177/0268355519835618

M3 - Article

JO - Phlebology

JF - Phlebology

SN - 1433-3031

ER -