Catheter-directed Thrombolysis versus Anticoagulation for the Prevention of Post-thrombotic Syndrome in lower extremity Deep Vein Thrombosis: A Systematic Review and Meta-analysis

Sunday, March 5, 2023

3:45 PM – 3:54 PM

Location: Phoenix Convention Center, 221C

Presenting Author(s)

AH

Ashkan Heshmatzadeh Behzadi, MD (he/him/his)

Vascular and Interventional Radiology Resident
University of Minnesota

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

IL

Igor Latich, MD

Associate Professor
Yale University
MP

Martin Prince, M.D. , PhD

Professor of Radiology
Cornell Medical University
HM

Hamid Mojibian, M.D.

Associate Professor
Yale School of Medicine

Disclosure(s):

Ashkan Heshmatzadeh Behzadi, MD: No financial relationships to disclose

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.

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 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 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. This 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 moderate to severe and short-term PTS, respectively (OR: 0.68; 95% CI:
0.5–0.95(P=0.02); I 2 (0.0%) and (OR: 0.59; 95% CI: 0.43–0.81(p= 0.001); I 2 (81.7%).
This 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%), or death between two patients group (OR: 0.83;
95% CI: 0.3– 2.3), I2 (86.0%).

Conclusion: Present 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.