74 - Catheter Directed Thrombolysis in Prevention of Post-thrombotic Syndrome after Deep Vein Thrombosis: A Meta-analysis
A. Behzadi, B. Amoozgar, M. Prince, H. Mojibian
Purpose: We performed a meta-analysis assessing the benefits of additional catheter-directed thrombolysis(CDT) for the prevention of post-thrombotic syndrome(PTS) compared with standard oral anticoagulation therapy in patients with lower extremity deep-vein thrombosis.
Material and Methods: This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of databases was conducted by 2 researchers independently for clinical trials Medline, Embase, and Cochrane Central were reviewed. Outcomes of interest included short-term (≤ 12 months) and long-term post-thrombotic syndrome (24≤ months), mortality, and bleeding. A random-effects model meta-analysis was performed. Heterogeneity was reported with the I2 statistic, >50% of I2 was considered to be statistically significant.
Results: A total of 315 papers were identified. After further screening the abstracts, 42 articles were then assessed in full for eligibility. 5 papers finally met inclusion criteria. Our meta-analysis showed additional catheter-directed thrombolysis does significantly not change the risk of long term post-thrombotic syndrome (OR: 0.56; 95% CI: 0.27–1.2 (P= 0.44); I2 (81.7%). However, CDT was more likely to prevent decreased rates of short term PTS (OR: 0.59; 95% CI: 0.43–0.81(p= 0.001); I2 (81.7%). In addition, an analysis based on 3 papers showed CDT was associated with decreased rates of moderate to severe short-term PTS (OR: 0.68; 95% CI: 0.5–0.95(P=0.02); I2 (0.0%) (Fig3). Our meta-analysis showed that additional CDT does not significantly change the incidence of bleeding complications. (OR: 1.06; 95% CI: 0.67–3.8; I2 (10.0%). The overall death rate in the whole cohort was 1.5%; 8 patients in the CDT group compared to 11 patients in the AC group. No difference was found between the two groups (OR: 0.83; 95% CI: 0.3– 2.3), I2 (86.0%).
Conclusions: Our meta-analysis showed that CDT does not change the long-term risk of post-thrombotic syndrome. However, CDT decreases short-term, moderate to severe post-thrombotic syndrome rates compared to anticoagulation therapy alone when used for the treatment of deep vein thrombosis without incurring a detectable increase in bleeding complications. The decision to utilize CDT to prevent PTS should be individualized according to patient risk factors for developing PTS.