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.
N1 - Publisher Copyright:
© The Author(s) 2019.
PY - 2019/12/1
Y1 - 2019/12/1
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; 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.
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; 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.
KW - Deep vein thrombosis
KW - catheter-directed thrombolysis
KW - post-thrombotic syndrome
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U2 - 10.1177/0268355519835618
DO - 10.1177/0268355519835618
M3 - Article
C2 - 30871438
AN - SCOPUS:85063046219
SN - 0268-3555
VL - 34
SP - 675
EP - 682
JO - Phlebology
JF - Phlebology
IS - 10
ER -