Nie Menglin, Peng Minyong, Liu Qiulei, Cao Yida, Xing Chenxu, Wu Zhiyuan, Zhang Wayne W
Independent Cardiovascular Research Lab, Chinese Institutes for Medical Research, Capital Medical University, Beijing, China; Department of Vascular Surgery, Anzhen Hospital, Capital Medical University, Beijing, China.
Independent Cardiovascular Research Lab, Chinese Institutes for Medical Research, Capital Medical University, Beijing, China.
Eur J Vasc Endovasc Surg. 2025 Sep 18. doi: 10.1016/j.ejvs.2025.09.019.
This systematic review aimed to compare the effects of pharmacomechanical thrombectomy vs. catheter directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (DVT) in preventing post-thrombotic syndrome (PTS).
PubMed, Embase, and the Cochrane Library from inception until September 2024.
A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines by searching PubMed, Embase, and the Cochrane Library for relevant studies from inception until September 2024. The primary outcome was overall risk of PTS, while secondary outcomes included the risks of different PTS classifications and safety outcomes. Safety outcomes were observed by bleeding events, haemoglobinuria, and acute kidney injury (AKI). Risk of bias was evaluated with the ROBINS-I) tool. Study quality was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
Thirteen retrospective cohort studies with 1 742 patients were included. Use of pharmacomechanical thrombectomy for DVT treatment was associated with a lower risk of PTS compared with CDT alone (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.43 - 0.71; p < .001). Pharmacomechanical thrombectomy was associated with a reduced risk of mild PTS (OR 0.56, 95% CI 0.37 - 0.86; p = .008), moderate to severe PTS and or venous ulcers (OR 0.40, 95% CI 0.25 - 0.66; p < .001), and severe PTS and or venous ulcers (OR 0.34, 95% CI 0.19 - 0.59; p = .001). A similar trend was observed for reduced risk of moderate PTS (OR 0.57, 95% CI 0.31 - 1.04; p = .067). Pharmacomechanical thrombectomy was associated with a lower risk of bleeding events compared with CDT (OR 0.58, 95% CI 0.41 - 0.81; p = .001), while haemoglobinuria (OR 20.08, 95% CI 4.57 - 88.19; p < .001) and AKI (OR 3.00, 95% CI 1.12 - 8.01; p = .029) occurred more. GRADE certainty was low or very low for all outcomes.
Compared with CDT, pharmacomechanical thrombectomy may reduce the risk of PTS of any degree in patients with DVT, while large and well designed studies are needed owing to the very low certainty of evidence.
本系统评价旨在比较药物机械性血栓切除术与导管直接溶栓术（CDT）治疗髂股深静脉血栓形成（DVT）在预防血栓形成后综合征（PTS）方面的效果。
自建库至2024年9月的PubMed、Embase和Cochrane图书馆。
按照系统评价和Meta分析的首选报告项目指南进行系统评价和Meta分析，通过检索PubMed、Embase和Cochrane图书馆，查找自建库至2024年9月的相关研究。主要结局是PTS的总体风险，次要结局包括不同PTS分类的风险和安全性结局。通过出血事件、血红蛋白尿和急性肾损伤（AKI）观察安全性结局。采用ROBINS-I工具评估偏倚风险。通过推荐分级评估、制定和评价（GRADE）评估研究质量。
纳入13项回顾性队列研究，共1742例患者。与单纯CDT相比，使用药物机械性血栓切除术治疗DVT与较低的PTS风险相关（优势比[OR]0.55，95%置信区间[CI]0.43 - 0.71；p <.001）。药物机械性血栓切除术与轻度PTS风险降低相关（OR 0.56，95% CI 0.37 - 0.86；p =.008），中度至重度PTS和/或静脉溃疡风险降低（OR 0.40，95% CI 0.25 - 0.66；p <.001），重度PTS和/或静脉溃疡风险降低（OR 0.34，95% CI 0.19 - 0.59；p =.001）。在中度PTS风险降低方面观察到类似趋势（OR 0.57，95% CI 0.31 - 1.04；p =.067）。与CDT相比，药物机械性血栓切除术与较低的出血事件风险相关（OR 0.58，95% CI 0.41 - 0.81；p =.001），而血红蛋白尿（OR 20.08，95% CI 4.57 - 88.19；p <.001）和AKI（OR 3.00，95% CI 1.12 - 8.01；p =.029）发生率更高。所有结局的GRADE确定性均为低或极低。
与CDT相比，药物机械性血栓切除术可能降低DVT患者任何程度PTS的风险，但由于证据确定性极低，需要开展大型且设计良好的研究。
