NDLI: Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis.

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Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Du, Guo-Cheng Zhang, Mao-Chun Zhao, Ji-Chun
Description	Country affiliation: China Author Affiliation: Du GC ( 1 Department of Diagnostic Ultrasound for Obstetrics and Gynecology, the Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.)
Abstract	BACKGROUND: The aim of this meta-analysis was to compare the clinical outcomes of catheter-directed thrombolysis (CDT) plus anticoagulation with anticoagulation alone in patients with lower-extremity proximal deep vein thrombosis (DVT). PATIENTS AND METHODS: We systematically searched Pubmed, Embase, and the Cochrane Library from inception to October, 2014. All randomized controlled trials (RCTs) and non-randomized studies comparing the clinical outcomes between additional CDT and anticoagulation alone were included. The primary outcomes were postthrombotic syndrome and major bleeding complications. The secondary outcomes included the iliofemoral patency rate, deep venous function, mortality, pulmonary embolism, and recurrent DVT. RESULTS: Three RCTs and 3 non-randomized studies were included. Compared with standard anticoagulation treatment, additional CDT was associated with a significantly higher rate of complete lysis within 30 days (OR = 91; 95 % CI 19.28 to 429.46), a higher rate of 6-month patency (OR = 5.77; 95 % CI 1.99 to 16.73), a lower rate of postthrombotic syndrome (OR = 0.4; 95 % CI 0.19 to 0.96), and a lower rate of venous obstruction (OR = 0.20; 95 % CI 0.09 to 0.44). More major bleeding episodes occurred in the CDT group (Peto OR 2.0; 95 % CI 1.62 to 2.62). CDT was not found to reduce mortality, pulmonary embolism, or recurrent DVT. CONCLUSIONS: Additional CDT therapy appeared to be more effective than standard anticoagulation treatment in improving the venous patency and preventing venous obstruction and postthrombotic syndrome. Caution should be taken when performing CDT given the increased risk of major bleeding. However, no evidence supported benefits of CDT in reducing mortality, recurrent DVT, or pulmonary embolism.
File Format	HTM / HTML
ISSN	03011526
e-ISSN	16642872
Journal	Vasa
Issue Number	3
Volume Number	44
Language	English
Publisher	Hogrefe Verlag
Publisher Date	2015-05-01
Publisher Place	Switzerland
Access Restriction	Open
Subject Keyword	Discipline Cardiology Anticoagulants Therapeutic Use Catheterization Fibrinolytic Agents Administration & Dosage Lower Extremity Blood Supply Thrombolytic Therapy Venous Thrombosis Drug Therapy Adverse Effects Drug Therapy, Combination Hemorrhage Chemically Induced Odds Ratio Postthrombotic Syndrome Etiology Prevention & Control Risk Factors Time Factors Vascular Patency Blood Diagnosis Physiopathology Meta-analysis
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine

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