Catheter-directed thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: a systematic review.

Methods of delivery of thrombolytic agents for massive or limb threatening deep venous thrombosis (DVT) include a systemic infusion, local-regional administration, and catheter-directed therapy (tip of catheter placed inside the thrombus). We evaluated the effectiveness of catheter-directed therapy and compared the results with randomized clinical trials of systemic and local-regional thrombolytic therapy. Many who used catheter-directed thrombolysis used balloon angioplasty, stents, or thrombectomy in addition. Pooled data showed higher rates of complete early opening of occluded veins with catheter-directed thrombolysis alone, 90%, or with catheter-directed thrombolysis often followed by adjunct therapy, 76%, than with a systemic infusion, 28%, or local-regional administration, 20%. The prevalence of postthrombotic syndrome was lower with catheter-directed combined with adjunct therapy, 26%, compared with 56% and 69%, respectively. Rates of any bleeding were higher with catheter-directed thrombolytic therapy, but bleeding was usually minor. In conclusion, the data suggest that catheter-directed thrombolytic therapy may be more beneficial than systemic or local regional administration. An advantage is that it lends itself to adjunct treatment following the administration of thrombolytic agents if the thrombolysis is inadequate.