Lu Yongming, Chen Linyi, Chen Jinhui, Tang Tao
1 Department of Vascular Surgery, Enze Hospital of Zhejiang Province, Taizhou, Zhejiang, China.
2 Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang, China.
Clin Appl Thromb Hemost. 2018 Oct;24(7):1134-1143. doi: 10.1177/1076029617739703. Epub 2017 Nov 13.
Standard anticoagulant treatment alone for acute lower extremity deep vein thrombosis (DVT) is ineffective in eliminating thrombus from the deep venous system, with many patients developing postthrombotic syndrome (PTS). Because catheter-directed thrombolysis (CDT) can dissolve the clot, reducing the development of PTS in iliofemoral or femoropopliteal DVT. This meta-analysis compares CDT plus anticoagulation versus standard anticoagulation for acute iliofemoral or femoropopliteal DVT. Ten trials were included in the meta-analysis. Compared with anticoagulant alone, CDT was shown to significantly increase the percentage patency of the iliofemoral vein ( P < .00001; I = 44%) and reduce the risk of PTS ( P = .0002; I = 79%). In subgroup analysis of randomized controlled trials, CDT was not shown to prevent PTS ( P = .2; I = 59%). A reduced PTS risk was shown, however, in nonrandomized trials ( P < .00001; I = 47%). Meta-analysis showed that CDT can reduce severe PTS risk ( P = .002; I = 0%). However, CDT was not indicated to prevent mild PTS ( P = .91; I = 79%). A significant increase in bleeding events ( P < .00001; I = 33%) and pulmonary embolism (PE) ( P < .00001; I = 14%) were also demonstrated. However, for the CDT group, the duration of stay in the hospital was significantly prolonged compared to the anticoagulant group ( P < .00001; I = 0%). There was no significant difference in death ( P = .09; I = 0%) or recurrent venous thromboembolism events ( P = .52; I = 58%). This meta-analysis showed that CDT may improve patency of the iliofemoral vein or severe PTS compared with anticoagulation therapy alone, but measuring PTS risk remains controversial. However, CDT could increase the risk of bleeding events, PE events, and duration of hospital stay.
对于急性下肢深静脉血栓形成（DVT），单纯采用标准抗凝治疗无法有效清除深静脉系统中的血栓，许多患者会发展为血栓后综合征（PTS）。由于导管直接溶栓（CDT）能够溶解血栓，可降低髂股或股腘静脉DVT患者发生PTS的风险。本荟萃分析比较了CDT联合抗凝治疗与标准抗凝治疗对急性髂股或股腘静脉DVT的疗效。该荟萃分析纳入了10项试验。与单纯抗凝治疗相比，CDT可显著提高髂股静脉的通畅率（P <.00001；I² = 44%）并降低PTS风险（P =.0002；I² = 79%）。在随机对照试验的亚组分析中，CDT未显示出可预防PTS（P =.2；I² = 59%）。然而，在非随机试验中显示PTS风险有所降低（P <.00001；I² = 并降低PTS风险（P =.0002；I² = 79%）。在随机对照试验的亚组分析中，CDT未显示出可预防PTS（P =.2；I² = 59%）。然而，在非随机试验中显示PTS风险有所降低（P <.00001；I² = 47%）。荟萃分析表明，CDT可降低严重PTS风险（P =.002；I² = 0%）。然而，CDT并未显示出可预防轻度PTS（P =.91；I² = 79%）。同时还证实出血事件（P <.00001；I² = 33%）和肺栓塞（PE）（P <.00001；I² = 14%）显著增加。然而，与抗凝治疗组相比，CDT组的住院时间显著延长（P <.00001；I² = 0%）。在死亡（P =.09；I² = 0%）或复发性静脉血栓栓塞事件方面无显著差异（P =.52；I² = 58%）。本荟萃分析表明，与单纯抗凝治疗相比，CDT可能改善髂股静脉通畅率或降低严重PTS风险，但评估PTS风险仍存在争议。然而，CDT可能会增加出血事件、PE事件的风险以及住院时间。
