Pharmacomechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Iliofemoral Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

Abstract

Early catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT) can reduce postthrombotic morbidity. Pharmacomechanical thrombolysis (PMT) is a new therapy that can be selected for the treatment of iliofemoral deep vein thrombosis (IFDVT). We performed a meta-analysis of clinical trials comparing PMT versus CDT for treatment of acute IFDVT. Literature on this topic published between January 1, 1990, and June 1, 2018, was identified using PubMed, Embase, Cochrane Library, and Web of Science. Six trials were included in the meta-analysis. Compared to CDT, PMT significantly reduced the Villalta score ( P = .007; I² = 0%), thrombus score ( P = .01; I² = 0%), the duration in the hospital ( P = .03; I² = 64%), and thrombolysis time ( P < .00001, I² = 0%). There was no significant difference in valvular incompetence events ( P = .21; I² = 0%), minor bleeding events ( P = .59; I² = 0%), stent events ( P = .09; I² = 24%), and clot reduction grade I events ( P = .16; I² = 43%) between PMT and CDT. Subgroup analysis was performed by dividing the clot reduction grade I events group into PMT plus CDT versus CDT group and significant differences were found ( P = .03, I² = 0%) as well as for PMT alone versus CDT group ( P = .88, I² = 37%). This meta-analysis shows that PMT reduces the severity of postthrombotic syndrome (PTS), thrombus score, duration in hospital, and thrombolysis time compared to CDT. More specifically, PMT plus CDT reduces clot reduction grade I events. No significant difference in valvular incompetence events, stent events, and minor bleeding events were found when PMT was compared to CDT.

Keywords: catheter-directed thrombolysis; iliofemoral deep vein thrombosis; pharmacomechanical thrombectomy.

Figure 1.

Flow diagram of literature review.

Figure 2.

Meta-analysis of primary outcomes of clinical trials (Villata score P = .007, I ² = 0%, thrombus score P = .01, I ² = 0%, valvular incompetence events P = .21, I ² = 0%).

Figure 3.

Meta-analysis of primary outcomes of clot reduction grade I events on primary outcomes with subgroup analysis. (total P = .16, I ² = 43%), PMT alone versus CDT group (P = .88, I ² = 37%), and PMT + CDT versus CDT group (P = .03, I ² = 0%). CDT indicates catheter-directed thrombolysis; M-H, Mantel-Haenszel (a stratification analysis method); PMT, pharmacomechanical thrombolysis.

Figure 4.

Meta-analysis of secondary outcomes of clinical trials (stent events P = .09, I ² = 24%; minor bleeding events P = .59, I ² = 0%, duration of hospital stay P = .03, I ² = 64%, and thrombolysis time P < .00001, I ² = 0%).