Treatment of acute iliofemoral deep vein thrombosis.

Abstract

OBJECTIVE:

The objective of this systematic review and meta-analysis was to compare the efficacy of three available treatments for acute iliofemoral deep vein thrombosis (DVT): systemic anticoagulation, surgical thrombectomy, and catheter-directed thrombolysis.

METHODS:

We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and Scopus) and sought additional references from experts. Eligible studies enrolled participants with acute iliofemoral DVT and measured the outcomes of interest. Reviewers working independently in duplicate extracted study characteristics, quality, and outcome data (death, pulmonary embolism, local complications, hemorrhagic complications, postthrombotic syndrome, pain, quality of life, and surrogate markers of venous function such as valve competence and patency). We pooled relative risks (RRs) from each study using the random effects model and estimated the 95% confidence intervals (CIs). Bayesian indirect comparison techniques were used to compare thrombectomy to catheter-directed thrombolysis.

RESULTS:

We found 15 unique studies that fulfilled eligibility criteria. When compared to systemic anticoagulation, thrombectomy was associated with a statistically significant reduction in the risk of developing postthrombotic syndrome (RR, 0.67; 95% CI, 0.52-0.87), venous reflux (RR, 0.68; 95% CI, 0.46-0.99), and a trend for reduction in the risk of venous obstruction (RR, 0.84; 95% CI, 0.60-1.19). When compared to systemic anticoagulation, pharmacologic catheter-directed thrombolysis was associated with statistically significant reduction in the risk of postthrombotic syndrome (RR, 0.19; 95% CI, 0.07-0.48), venous obstruction (RR, 0.38; 95% CI, 0.18-0.37), and a trend for reduction in the risk of venous reflux (RR, 0.39; 95% CI, 0.16-1.00). Overall, the quality of evidence was low; downgraded due to the observational nature of the majority of studies, lack of comparability of study cohorts at baseline, loss to follow-up, imprecision, and indirectness of outcomes (surrogacy). There were insufficient data to compare the outcomes of thrombectomy to catheter-directed thrombolysis.

CONCLUSIONS:

Low-quality evidence suggests that surgical thrombectomy decreases the incidence of postthrombotic syndrome and venous reflux. Catheter-directed pharmacologic thrombolysis decreases the incidence of postthrombotic syndrome and venous obstruction.

• Authors: Edward T Casey, M Hassan Murad, Magaly Zumaeta-Garcia, Mohamed B Elamin, Qian Shi, Patricia J Erwin, Victor M Montori, Peter Gloviczki, Mark Meissner
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 55 Issue 5 Pg. 1463-73 (May 2012) ISSN: 1097-6809 [Electronic] United States
• PMID: 22440631 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Chemical References

• Anticoagulants
• Fibrinolytic Agents

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (adverse effects, therapeutic use)
• Bayes Theorem
• Evidence-Based Medicine
• Female
• Femoral Vein
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Humans
• Iliac Vein
• Male
• Middle Aged
• Postthrombotic Syndrome (etiology, prevention & control)
• Risk Assessment
• Risk Factors
• Thrombectomy (adverse effects)
• Thrombolytic Therapy (adverse effects)
• Treatment Outcome
• Venous Thrombosis (complications, therapy)
• Young Adult