Key result
CDT plus AC cuts post-thrombotic syndrome risk ~72% versus AC alone.
Why the study?
Post-thrombotic syndrome is a complication after deep vein thrombosis of lower extremities, and the comparative efficacy of treatment modalities to reduce PTS risk is unclear.
Does catheter-directed thrombolysis plus anticoagulation reduce the risk of post-thrombotic syndrome in patients with lower extremity deep vein thrombosis?
Meta-Analysis
Does catheter-directed thrombolysis plus anticoagulation reduce the risk of post-thrombotic syndrome in patients with lower extremity deep vein thrombosis?
Odds Ratio: 0.28 (95% CI 0.12–0.64)
CDT plus anticoagulation reduces the risk of post-thrombotic syndrome in DVT patients but is associated with a three-fold increase in bleeding risk.
Supports CDT plus anticoagulation to reduce post-thrombotic syndrome in lower extremity DVT; confirms benefit but cautions on threefold bleeding increase.
Post-thrombotic syndrome (PTS) is a complication that can develop after deep vein thrombosis (DVT) of lower extremities. In this meta-analysis, we compare the different modalities for treatment of DVT in reducing the risk of PTS. The primary outcome was the risk of PTS, and the secondary outcome included the risk of bleeding events. Review Manager (version 5.3; Cochrane Collaboration software) was used to analyze the data that are represented as a forest plot. Meta-analysis indicated that catheter-directed thrombolysis (CDT) plus anticoagulation (AC) decreases the likelihood of developing PTS compared with the AC-only group with an odds ratio of 0.28 (0.12-0.64). A subgroup analysis of randomized control trial (RCT) studies was conducted, and findings suggest a slight decrease in the likelihood of PTS incidence in the CDT+AC treatment group compared to the AC treatment group (odds ratio, OR = 0.76; CI = 0.58-0.99). For the secondary outcome, a statistically significant increase in bleeding events in the intervention groups was reported with an OR of 3.38 (1.33-8.61), suggesting that the risk of bleeding was high in the CDT plus AC group. CDT in addition to conventional AC for patients with DVT decreases the likelihood of PTS development. The protective effect of CDT comes at the expense of an increase in bleeding risk by three-fold. The decision to utilize CDT to prevent PTS should be individualized according to patient risk factors for developing PTS and their risk of bleeding.
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Alhazmi et al. (2019) conducted a meta-analysis in Deep vein thrombosis (DVT) of lower extremities. Catheter-directed thrombolysis (CDT) plus anticoagulation (AC) vs. Anticoagulation (AC) only was evaluated on Risk of post-thrombotic syndrome (PTS) (OR 0.28, 95% CI 0.12-0.64). Catheter-directed thrombolysis plus anticoagulation decreased the likelihood of developing post-thrombotic syndrome compared with anticoagulation alone (OR 0.28; 95% CI 0.12-0.64).
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