Catheter-directed thrombolysis for patients with acute lower extremity deep vein thrombosis: a meta-analysis.
Wang Li, Zhang Chuanlin, Mu Shaoyu and 3 others
PMID 29947719WHAT IT FOUND
In acute lower extremity DVT, catheter-directed thrombolysis plus anticoagulation was linked to less post-thrombotic syndrome and better vein patency than anticoagulation alone, but rethrombosis did not differ.
Most evidence was case series.
Key findings
01In comparison studies where CDT was given with anticoagulation, the CDT plus anticoagulation arm had lower odds of post-thrombotic syndrome (OR 0.38, 95%CI 0.26-0.55, p<0.0001) and higher 6-month patency (OR 4.76, 95%CI 2.14-10.56, p<0.0001) than anticoagulation alone.
02In case series of CDT, with or without anticoagulation or stent, pooled proportions were PTS 0.10 (0.08, 0.12), patency 0.87 (0.85, 0.89), complete lysis 0.58 (0.40, 0.75), and rethrombosis 0.11 (0.06, 0.17).
03Rethrombosis did not differ between CDT plus anticoagulation and anticoagulation alone in the two comparison studies reporting it (OR 0.55, 95%CI 0.04-5.42, p>0,05).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most included studies were case series without a comparison group, so they cannot show that CDT caused the outcomes. Almost half of the studies were retrospective, so recall bias cannot be ruled out. Patency data were affected by publication bias, likely because positive CDT results are more likely to be published. Only peer-reviewed English studies were included. Heterogeneity was high for complete lysis and rethrombosis. The comparison analyses were based on a small number of studies for each outcome. Because CDT was given with anticoagulation, and sometimes with stent placement, the contribution of any single component cannot be separated.
The easy way to misread this
Do not conclude that catheter-directed thrombolysis alone is proven better than anticoagulation for all acute leg DVT. The treatment arm included anticoagulation, and sometimes stent placement, so the contribution of any single component cannot be separated. Also, many studies were case series without controls, rethrombosis did not improve, and patency was affected by publication bias.