Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Nov 4;11(11):CD011536.
doi: 10.1002/14651858.CD011536.pub2.

Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis

Affiliations

Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis

Lindsay Robertson et al. Cochrane Database Syst Rev. .

Abstract

Background: Deep venous thrombosis (DVT) occurs in approximately one in 1000 adults every year, and has an annual mortality of 14.6%. In particular, iliofemoral DVT can lead to recurrent thrombosis and post-thrombotic syndrome (PTS), a painful condition which can lead to chronic venous insufficiency, oedema, and ulceration. It causes significant disability, impaired quality of life, and economic burden. Early thrombus removal techniques have been advocated in patients with an iliofemoral DVT in order to improve vein patency, prevent valvular dysfunction, and reduce future complications, such as post-thrombotic syndrome and venous ulceration. One such technique is pharmacomechanical thrombectomy, a combination of catheter-based thrombectomy and catheter-directed thrombolysis.

Objectives: To assess the effects of pharmacomechanical thrombectomy versus anticoagulation (alone or with compression stockings), mechanical thrombectomy, thrombolysis, or other endovascular techniques in the management of people with acute DVT of the iliofemoral vein.

Search methods: The Cochrane Vascular Information Specialist searched the Specialised Register (last searched December 2015) and the Cochrane Register of Studies (last searched December 2015). We searched clinical trials databases for details of ongoing or unpublished studies and the reference lists of relevant articles retrieved by electronic searches for additional citations.

Selection criteria: Randomised controlled trials in which patients with an iliofemoral deep vein thrombosis were allocated to receive pharmacomechanical thrombectomy versus anticoagulation, mechanical thrombectomy, thrombolysis (systemic or catheter directed thrombolysis), or other endovascular techniques for the treatment of iliofemoral DVT.

Data collection and analysis: At least two review authors independently assessed studies identified for potential inclusion.

Main results: We found no randomised controlled trials that met the eligibility criteria for this review. We identified one ongoing study.

Authors' conclusions: There were no randomised controlled trials that assessed the effects of pharmacomechanical thrombectomy versus anticoagulation (alone or with compression stockings), mechanical thrombectomy, thrombolysis, or other endovascular techniques in the management of people with acute DVT of the iliofemoral vein that met the eligibility criteria for this review. Further high quality randomised controlled trials are needed.

PubMed Disclaimer

Conflict of interest statement

LR: none known OM: none known AD: none known

Figures

1
1
Study flow diagram.

Update of

  • doi: 10.1002/14651858.CD011536

References

References to studies excluded from this review

Cakir 2014 {published data only}
    1. Cakir V, Gulcu A, Akay E, Capar AE, Gencpinar T, Kucuk B, et al. Use of percutaneous aspiration thrombectomy vs. anticoagulation therapy to treat acute iliofemoral venous thrombosis: 1‐year follow‐up results of a randomised, clinical trial. Cardiovascular and Interventional Radiology 2014;37(4):969‐76. - PubMed
    1. Cakir V, Gülcü A, Kucuk B, Capar AE, Gencpinar T, Karabay O, et al. Early results of percutaneous aspiration thrombectomy vs. anticoagulation in acute iliofemoral venous trombosis: a randomised clinical trial. Cardiovascular and Interventional Radiology 2011;34(Suppl 3):524. - PubMed
Srinivas 2014 {published and unpublished data}
    1. Patra S. Catheter directed thrombolysis along with mechanical thromboaspiration versus anticoagulation alone in the management of lower limb deep venous thrombosis ‐ a comparative study. Journal of the American College of Cardiology 2014;64(16 Suppl 1):C203. - PMC - PubMed
    1. Srinivas BC, Patra S, Nagesh CM, Reddy B, Manjunath CN. Catheter‐directed thrombolysis along with mechanical thromboaspiration versus anticoagulation alone in the management of lower limb deep venous thrombosis ‐ a comparative study. International Journal of Angiology 2014;23(4):247‐54. - PMC - PubMed

References to studies awaiting assessment

TORPEDO 2012 {published data only}
    1. Sharifi M, Bay C, Mehdipour M, Sharifi J, for the TORPEDO Investigators. Thrombus Obliteration by Rapid Percutaneous Endovenous Intervention in Deep Venous Occlusion (TORPEDO) trial: midterm results. Journal of Endovascular Therapy 2012;19(2):273‐80. - PubMed

References to ongoing studies

NCT02414802 {published data only}
    1. NCT02414802. Study of a novel thrombectomy device to treat acute iliofemoral deep venous thrombosis. Available from clinicaltrials.gov/ct2/show/NCT02414802 (accessed 17 December 2015).

Additional references

Access Economics Pty Limited 2008
    1. Access Economics Pty Limited. The burden of venous thromboembolism in Australia. Report by Access Economics Pty Limited for The Australia and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism. 1 May 2008. Available from www.deloitteaccesseconomics.com.au/uploads/File/The%20burden%20of%20VTE%... (accessed 28 January 2015).
Ageno 2006
    1. Ageno W, Squizzato A, Garcia D, Imberti D. Epidemiology and risk factors of venous thromboembolism. Seminars in Thrombosis and Hemostasis 2006;32(7):651‐8. - PubMed
Atkins 2004
    1. Atkins D, Best D, Briss PA, Eccles M, Falck‐Ytter Y, Flottorp S, et al. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490. - PMC - PubMed
Blackwood 2016
    1. Blackwood S, Dietzek AM. Pharmacomechanical thrombectomy: 2015 update. Expert Review of Cardiovascular Therapy 2016;17:1‐13. [DOI: 10.1586/14779072.2016.1140038] - DOI - PubMed
Elliot 1979
    1. Elliot MS, Immelman EJ, Jeffery P, Benatar SR, Funston MR, Smith JA, et al. A comparative randomized trial of heparin versus streptokinase in the treatment of acute proximal venous thrombosis: an interim report of a prospective trial. British Journal of Surgery 1979;66(12):838‐43. - PubMed
Enden 2009
    1. Enden T, Klow NE, Sandvik L, Slagsvold CE, Ghanima W, Hafsahl G, et al. Catheter‐directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short‐term patency. Journal of Thrombosis and Haemostasis 2009;7(8):1268‐75. - PubMed
GRADEproGDT [Computer program]
    1. GRADE Working Group, McMaster University. GRADEproGDT. Hamilton (ON): GRADE Working Group, McMaster University, 2015.
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Jenkins 2011
    1. Jenkins JS. Endovascular therapies to treat iliofemoral deep venous thrombosis. Progress in Cardiovascular Disease 2011;54(1):70‐6. - PubMed
Kahn 2014
    1. Kahn SR, Shapiro S, Wells PS, Rodger MA, Kovacs MJ, Anderson DR, et al. SOX trial investigators. Compression stockings to prevent post‐thrombotic syndrome: a randomised placebo‐controlled trial. Lancet 2014;383(9920):880‐8. - PubMed
Kearon 2003
    1. Kearon C. Natural history of venous thromboembolism. Circulation 2003;107(23 Suppl 1):I22‐30. - PubMed
Merli 2008
    1. Merli GJ. Treatment of venous thromboembolism. American Journal of Medicine 2008;121(11A):S8‐3.
Musani 2010
    1. Musani MH, Matta F, Yaekoub AY, Liang J, Hull RD, Stein PD. Venous compression for prevention of postthrombotic syndrome: a meta‐analysis. American Journal of Medicine 2010;123(8):735‐40. - PubMed
Pappy 2010
    1. Pappy R, Hanna EB, Abu‐Fadel MS, Hennebry TA. Isolated pharmacomechanical thrombectomy for the management of chronic DVT. Journal of Interventional Cardiology 2011;24(1):104‐99. - PubMed
Plate 1990
    1. Plate G, Akesson H, Einarsson E, Ohlin P, Eklof B. Long‐term results of venous thrombectomy combined with a temporary arterio‐venous fistula. European Journal of Vascular Surgery 1990;4(5):483‐9. - PubMed
Prandoni 1992
    1. Prandoni P, Villalta S, Polistena P, Bernardi E, Cogo A, Girolami A. Symptomatic deep‐vein thrombosis and the post‐thrombotic syndrome. Haematologica 1995;80(2):42‐8. - PubMed
Prandoni 2004
    1. Prandoni P, Lensing AW, Prins MH, Frulla M, Marchiori A, Bernardi E, et al. Below‐knee elastic compression stockings to prevent the post‐thrombotic syndrome: a randomized, controlled trial. Annals of Internal Medicine 2004;141(4):249‐56. - PubMed
Prandoni 2009
    1. Prandoni P, Kahn SR. Post‐thrombotic syndrome: prevalence, prognostication and need for progress. British Journal of Haematology 2009;145(3):286‐95. - PubMed
Review Manager 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Schulman 2005
    1. Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patients. Journal of Thrombosis and Haemostasis 2005;3(4):692‐4. - PubMed
Strijkers 2015
    1. Strijkers RH, Arnoldussen CW, Wittens CH. Validation of the LET classification. Phlebology 2015;30(1 Suppl):14‐9. - PubMed
Suwanabol 2013
    1. Suwanabol PA, Hoch JR. Venous thromboembolic disease. Surgical Clinics of North America 2013;93(4):983‐95. - PubMed
Turpie 1990
    1. Turpie AG, Levine MN, Hirsh J, Ginsberg JS, Cruickshank M, Jay R, et al. Tissue plasminogen activator (rt‐PA) vs heparin in deep vein thrombosis. Results of a randomized trial. Chest 1990;97(4 Suppl):172S‐5S. - PubMed
Watson 2014
    1. Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database of Systematic Reviews 2014, Issue 1. [DOI: 10.1002/14651858.CD002783.pub3] - DOI - PubMed
White 2003
    1. White RH. The epidemiology of venous thromboembolism. Circulation 2003;107(23):14‐8. - PubMed

References to other published versions of this review

Robertson 2015
    1. Robertson L, Burdess A, McBride O. Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis. Cochrane Database of Systematic Reviews 2015, Issue 2. [DOI: 10.1002/14651858.CD011536] - DOI - PMC - PubMed

Publication types