Catheter-Directed Thrombolysis in Prevention of Post-thrombotic Syndrome after Deep Vein Thrombosis: A Meta-analysis

Purpose: We performed a meta-analysis assessing the benefits of additional catheter-directed thrombolysis(CDT) for the prevention of postthrombotic syndrome (PTS) compared with standard oral anticoagulation therapy in patients with lower extremity deep vein thrombosis (DVT).

Materials 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 two researchers independently for clinical trials Medline, Embase, and Cochrane Central were reviewed. Outcomes of interest included short-term (≤12 months) and long-term PTS (24≤ months), mortality rate, and bleeding. A random-effects model meta-analysis was performed. Heterogeneity was reported with the I² statistic; greater than 50% of I² was considered to be statistically significant.

Results: A total of 315 articles were identified. After further screening the abstracts, 42 articles were then assessed in full for eligibility. Five articles finally met inclusion criteria. Our meta-analysis showed additional CDT does significantly not change the risk of long term PTS (odds ratio [OR], 0.56; 95% confidence interval [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 three articles 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%). 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 with 11 patients in the anticoagulation 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 postthrombotic syndrome. However, CDT decreases short-term, moderate to severe PTS rates compared with anticoagulation therapy alone when used for the treatment of DVT without incurring a detectable increase in bleeding complications. The decision to use CDT to prevent PTS should be individualized according to patient risk factors for developing PTS.