Effects of thrombolysis on outcomes of patients with deep venous thrombosis: An updated meta-analysis
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Key result
Thrombolysis plus anticoagulation fails to reduce post-thrombotic syndrome versus anticoagulation alone in DVT.
- RR 0.90
- 95% CI 0.80-1.01
- P=0.19
- n=1,418
Why the study?
Previous small RCTs and meta-analyses suggested thrombolysis reduces post-thrombotic syndrome, but recent trials showed conflicting results.
Does thrombolysis combined with anticoagulation reduce post-thrombotic syndrome in patients with deep venous thrombosis?
Comparison
Thrombolysis plus anticoagulation vs anticoagulation alone
Design
Meta-analysis of randomized controlled trials
Follow-up
Longest follow-up period
Authors
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Implication
Thrombolysis adds no PTS benefit in DVT; confirms anticoagulation alone as standard while raising major bleeding concerns.
Study Design
Type
Meta-Analysis (n=1,418)
Structured PICO
Does thrombolysis combined with anticoagulation reduce post-thrombotic syndrome in patients with deep venous thrombosis?
P
Population
1,418 patients with deep venous thrombosis from 6 randomized controlled trials comparing thrombolysis plus anticoagulation versus anticoagulation alone, followed for 6 to 24 months.
I
Intervention
Thrombolysis (including catheter-directed thrombolysis) in combination with anticoagulation
C
Comparator
Anticoagulation alone
O
Outcome
Post-thrombotic syndrome (PTS) during the longest follow-up periodhard clinical
Main Result
Relative Risk: 0.9 (95% CI 0.8–1.01)
Absolute Event Rate: 52% vs 54%
p-value: p=0.19
Thrombolysis combined with anticoagulation for DVT does not significantly reduce post-thrombotic syndrome but increases the risk of major bleeding.
Limitations
- Small number of included studies
- Clinical heterogeneity due to different times of symptom onset, clinical characteristics, thrombolysis strategies, and follow-up duration
- Did not distinguish patients with transient risk factors from those with unchangeable risk factors
- Low incidence of major bleeding limited statistical power to draw firm conclusions on safety
- Results were not supported by trial sequential analysis (TSA) and sensitivity analysis
Cite This Study
Xing et al. (2018) conducted a meta-analysis in Deep venous thrombosis (DVT) (n=1,418). Thrombolysis in combination with anticoagulation vs. Anticoagulation alone was evaluated on Post-thrombotic syndrome (PTS) during the longest follow-up period (RR 0.90, 95% CI 0.80-1.01, p=0.19). Thrombolysis in combination with anticoagulation did not significantly reduce the incidence of post-thrombotic syndrome compared to anticoagulation alone in patients with deep venous thrombosis (RR 0.90, P=0.19).
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