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

1 Scopus citations

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; I2=87.2%), and to lead to iliofemoral vein patency (OR: 2.7; 95% CI: 1.08–6.75; I2=55.3%) but no difference was noted in thromboembolic events (OR = 0.5; 95% CI: 0.08–3.02, I2=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)
Pages (from-to)675-682
Number of pages8
JournalPhlebology
Volume34
Issue number10
DOIs
StatePublished - Dec 1 2019

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Mastoris, I., Kokkinidis, D. G., Bikakis, I., Archontakis-Barakakis, P., Papanastasiou, C. A., Jonnalagadda, A. K., Schizas, D., Bakoyiannis, C., Palaiodimos, L., & Faillace, R. T. (2019). 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. Phlebology, 34(10), 675-682. https://doi.org/10.1177/0268355519835618