Catheter-Directed Thrombolysis Versus Standard Anticoagulation for Acute Lower Extremity Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

Abstract

Standard anticoagulant treatment alone for acute lower extremity deep vein thrombosis (DVT) is ineffective in eliminating thrombus from the deep venous system, with many patients developing postthrombotic syndrome (PTS). Because catheter-directed thrombolysis (CDT) can dissolve the clot, reducing the development of PTS in iliofemoral or femoropopliteal DVT. This meta-analysis compares CDT plus anticoagulation versus standard anticoagulation for acute iliofemoral or femoropopliteal DVT. Ten trials were included in the meta-analysis. Compared with anticoagulant alone, CDT was shown to significantly increase the percentage patency of the iliofemoral vein ( P < .00001; I² = 44%) and reduce the risk of PTS ( P = .0002; I² = 79%). In subgroup analysis of randomized controlled trials, CDT was not shown to prevent PTS ( P = .2; I² = 59%). A reduced PTS risk was shown, however, in nonrandomized trials ( P < .00001; I² = 47%). Meta-analysis showed that CDT can reduce severe PTS risk ( P = .002; I² = 0%). However, CDT was not indicated to prevent mild PTS ( P = .91; I² = 79%). A significant increase in bleeding events ( P < .00001; I² = 33%) and pulmonary embolism (PE) ( P < .00001; I² = 14%) were also demonstrated. However, for the CDT group, the duration of stay in the hospital was significantly prolonged compared to the anticoagulant group ( P < .00001; I² = 0%). There was no significant difference in death ( P = .09; I² = 0%) or recurrent venous thromboembolism events ( P = .52; I² = 58%). This meta-analysis showed that CDT may improve patency of the iliofemoral vein or severe PTS compared with anticoagulation therapy alone, but measuring PTS risk remains controversial. However, CDT could increase the risk of bleeding events, PE events, and duration of hospital stay.

Keywords: anticoagulation; catheter-directed thrombolysis; deep vein thrombosis (DVT).

Figure 1.

Flow diagram of literature review.

Figure 2.

Meta-analysis of primary outcomes of clinical trials (patency of the iliofemoral vein 95% CI 2.36-4.67; risk for PTS 95% CI 0.51-0.82). CI indicates confidence interval; PTS, postthrombotic syndrome.

Figure 3.

Meta-analysis of the classification of PTS (risk for severe PTS 95% CI 0.46-0.94; risk for mild PTS 95% CI 0.74-1.39). CI indicates confidence interval; PTS, postthrombotic syndrome.

Figure 4.

Meta-analysis of adverse events (secondary outcomes) of clinical trials (bleeding events 95% CI 1.91-3.04; PE events 95% CI 1.47-1.92; death 95% CI 0.95-2.13; recurrent VTE 95% CI 0.76-1.72). CI indicates confidence interval; PE, pulmonary embolism; VTE, venous thrombus embolism.

Figure 5.

Meta-analysis of duration of hospital stay and hospital charges (secondary outcomes) of clinical trials (duration in hospital 95% CI 0.37-0.46; hospital charges 95% CI 0.86-1.07). CI indicates confidence interval.