Ng Tina T, Sigman Michael, Weaver Fred A
Division of Vascular Surgery and Endovascular Therapy, USC Cardiovascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Division of Vascular Surgery and Endovascular Therapy, USC Cardiovascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Ann Vasc Surg. 2014 May;28(4):1039-44. doi: 10.1016/j.avsg.2013.12.002. Epub 2014 Jan 16.
Treatment guidelines for thrombolysis in iliofemoral deep venous thrombosis (DVT) are based on a limited number of observational and prospective studies. The acute venous thrombosis: thrombus removal with adjunctive catheter-directed thrombolysis (ATTRACT) trial will be the first large, multicenter randomized control trial to evaluate the relative advantages of several current treatment strategies. The objective of this study was to summarize the existing data that inform the use of catheter-directed thrombolysis (CDT) or pharmacomechanical thrombectomy in the management of acute iliofemoral DVT.
A search of the current literature was done using PubMed, Ovid, and Cochrane databases for all available articles published up to December 2013.
Of those studies, which included at least 25 patients, 19 case series were identified from 1996 to 2012. Treatment groups included anticoagulation, surgical thrombectomy, pharmacomechanical thrombectomy, and CDT. Cases observed in each ranged from 26 to 101. Three studies were identified which derived data from national multicenter registries. Only 2 randomized control trials were identified from 2002 to 2012. Both support the use of CDT over anticoagulation alone for treatment of iliofemoral DVT.
Present treatment guidelines for acute iliofemoral DVT have been in flux and are derived from a relatively small amount of clinical data. They are summarized here in anticipation of results from the ongoing ATTRACT trial.
髂股深静脉血栓形成（DVT）的溶栓治疗指南是基于数量有限的观察性研究和前瞻性研究制定的。急性静脉血栓形成：辅助导管定向溶栓清除血栓（ATTRACT）试验将是首个评估当前几种治疗策略相对优势的大型多中心随机对照试验。本研究的目的是总结现有数据，这些数据为导管定向溶栓（CDT）或药物机械性血栓清除术在急性髂股DVT治疗中的应用提供了依据。
使用PubMed、Ovid和Cochrane数据库检索截至2013年12月发表的所有可用文章，对当前文献进行检索。
在那些至少纳入25例患者的研究中，1996年至2012年期间共确定了19个病例系列。治疗组包括抗凝、手术取栓、药物机械性血栓清除术和CDT。每组观察到的病例数从26例到101例不等。确定了3项从国家多中心登记处获取数据的研究。2002年至2012年期间仅确定了2项随机对照试验。两项试验均支持在治疗髂股DVT时使用CDT而非单纯抗凝治疗。
目前急性髂股DVT的治疗指南一直在变化，且源于相对较少的临床数据。在此进行总结，以期得到正在进行的ATTRACT试验的结果。
