The Efficacy and Safety of Conventional Methods Combined with Catheter-Directed Thrombolysis for Acute Deep Vein Thrombosis of Lower Extremity: A Meta-Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CAOJun-sheng ,  LUOJun , BAIChao , TIANYe

Center of Digestion and Vascular Surgery, Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China;

Corresponding author：

LUOJun, Email: xmuluo@163.com

Keywords：

Catheter-directed thrombolysis; Curative effect; Safety; Meta-analysis

DOI：

10.7507/1007-9424.20140111

Video：

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Objective To evaluate the effectiveness and safety of the additional catheter-directed thrombolysis (CDT) and conventional treatment (CT) for treatment primary deep vein thrombosis. Methods Databases such as CNKI, WanFang Data, Pubmed, EMBASE.com, Medline, CBM, CSJD, CJFD, and the Cochrane Library were electronically searched from the date of their establishment to 30 June, 2013, and the relevant literatures and conference proceedings were also manually searched to include randomized controlled trials (RCTs) on comparison of additional CDT versus CT for primary deep vein thrombosis. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and accessed the methodological quality of the included studies. Then the meta-analysis was performed by using RevMan 5.1 software. Publication bias was assessed by STATA software. A meta-regression model was used to describe between study variability. Results Two RCTs including 3 literatures contain 224 patients reporting data on safety and efficacy of CDT versus CT were included. There were no publication bias (Begg'S test, Z=1.02. P > 0.05;Egger'S test, t=0.98, P > 0.05). The results of meta-analysis showed that:in 6 months after surgery iliofemoral vein patency rate of CDT group was higher than that of CT group (OR=3.62, 95% CI:1.51-8.64, P=0.004), in 6 months after surgery CDT group with a lower rate than CT group of the iliofemoral vein occlusion and (or)venous reflux rate (OR=0.24, 95% CI:0.11-0.53, P=0.000), and the incidence rate of PTS in 24 months after surgery in CTD group was less than that of CT group (OR=0.55, 95% CI:0.31-0.96, P=0.040). There were no statistically significant of the major complications after surgery between CDT group and CT group (OR=1.34, 95% CI:0.12-15.69, P=0.810). But the incidence rates of minor complications and total complications after surgery in CT group were lower than those of CDT group (OR=13.67, 95% CI:4.08-45.83, P < 0.00 01 and OR=11.67, 95% CI:4.40-30.99, P < 0.000 01). Conclusions CDT is a effective and positive way to treat early deep venous thrombosis especially in terms of the patency of vascular and prevent the occlusion and PTS. Due to the limitation of the included studies, large sample size, multicenter, and high quality studies are needed to verify the above conclusion, such as the ATTRACT Study. The intracavitary therapy could be applied to clinic combining individual conditions of patients.

Citation： CAOJun-sheng, LUOJun, BAIChao, TIANYe. The Efficacy and Safety of Conventional Methods Combined with Catheter-Directed Thrombolysis for Acute Deep Vein Thrombosis of Lower Extremity: A Meta-Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(4): 458-466. doi: 10.7507/1007-9424.20140111 Copy

1.	颜新, 千英信, 卫洪昌, 等.下肢深静脉血栓形成的中医治疗进展[J].上海中医杂志, 2006, 37(3):58-60.
2.	陈孝平.外科学[M].北京:人民卫生出版社, 2005:792-794.
3.	Harenberg J. Fixed-dose versus adjusted-dose low molecular weight heparin for the initial treatment of patients with deep venous thrombosis[J]. Curr Opin Pulm Med, 2002, 8(5):383-388.
4.	Semba CP, Dake MD. Iliofemoral deep venous thrombosis:aggressive therapy with catheter-directed thrombolysis[J]. Radi-ology, 1994, 191(2):467-494.
5.	Kearon C, Kahn SR, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)[J]. Chest, 2008, 133(6 Supp1):454S-545S.
6.	Watson LI, Armon MP. Thrombolysis for acute deep vein throm-bosis[J]. Cochrane Database Syst Rev, 2004, 18(4):CD00-2783.
7.	刘关键, 吴泰相, 康德英. Meta-分析中统计学过程[J].中国临床康复, 2003, 7(4):538-539.
8.	吴泰相, 刘关键, 赵娜, 等.观察性研究系统评价/Meta-分析的方法[J].中国循证医学杂志, 2004, 4(5):337-341.
9.	Higgins JPT, Green S. Cochrane Handbook for SystematicReviews of Interventions Version 5. 0. 1(updated September 2008)[EB/OL]. The Cochrane Collaboration, 2008. Available from www. cochranehandbook. org.
10.	Enden T, Kløw NE, Sandvik L, et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis:results of an open randomized, controlled trial reporting on short-term patency[J]. J Thromb Haemost, 2009, 7(8):1268-1275.
11.	Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study):a randomised controlled trial[J]. Lancet, 2012, 379(9810):31-38.
12.	Elsharawy M, Elzayat E. Early results of thrombolysis versus anti-coagulation in iliofemoral venous thrombosis. A randomized clin-ical trial[J]. Eur J Vase Endovasc Surg, 2002, 24(3):209-214.
13.	Mewissen MW, Seabrook GR, Meissner MH, et al. Catheter-dir-ectedthrombolysis for lower extremity deep venous thrombosis:report of a national multicenter registry[J]. Radiology, 1999, 211(1):39-49.
14.	Semba CP, Razavi MK, Kee ST, et al. Thrombolysis for lower extremity deep venous thrombosis[J]. Tech Vasc Interv Radiology, 2004, 7(2):68-78.
15.	Bjarnason H, Kruse JR, Asinger DA, et al. Iliofemoral deep venous thrombosis:safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy[J]. J Vasc Interv Radiol, 1997, 8(3):405-418.
16.	Ly B, Njaastad AM, Sandbaek G, et al. Catheter-directed throm-bolysis of iliofemoral venous thrombosis[J]. Tidsskr Nor Laege-foren, 2004, 124(4):478-480.
17.	Sillesen H, Just S, Jørgensen M, et al. Catheter-directed thrombolysis for treatment of iliofemoral deep venous thrombosis is durable, preserves venous valve function and may prevent chroni-cvenous insufficiency[J]. Eur J Vasc Endovasc Surg, 2005, 30(5):556-562.
18.	Protack CD, Bakken AM, Pate N, et al. Long-term outcomes of catheter-directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement[J]. J Vasc Surg, 2007, 45(5):992-997.
19.	Meissner MH, Wakefield TW, Asher E, et al. Acute venous disease:venous thrombosis and venous trama[J]. J Vasc Surg, 2007, 46 Suppl S:25S-53S.
20.	Kearon C. Natural history of venous thromboembolism[J]. Circu-lation, 2003, 107(23 Suppl 1):I22-I30.
21.	Janssen MC, Wollersheim H, Schultze-Kool LJ, et al. Local and systemic thrombolytic therapy for acute venous thrombosis[J]. Neth J Med, 2005, 63(3):81-90.
22.	Comerota AJ, Schmieder FA. Intraoperative lytic therapy:agents and methods of administration[J]. Simin Vasc Surg, 2001, 14(2):132-142.
23.	Segal JB, Streiff MB, Hoffmann LV, et al. Management of ven-ous thromboembolism:a systematic review for a practice guideline[J]. Ann Intern Med, 2007, 146(3):211-222.
24.	Ogawa T, Hoshino S, Midorikawa H, et al. Intermittent pneumatic compression of the foot and calf improves the outcome of catheter-directed thrombolysis using low-dose urokinase in pati-ents with acute proximal venous thrombosis of the leg[J].J Vase Surg, 2005, 42(5):940-944.
25.	Kakkos SK, Daskalopoulou SS, Daskalopoulos ME, et al. Review on the value of graduated elastic compression stockings after deep vein thrombosis[J].Thromb Haemost, 2006, 96(4):441-445.
26.	Vedantham S, Goldhaber SZ, Kahn SR, et al. Rationale and design of the ATTRACT Study:a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis[J]. Am Heart J, 2013, 165(4):523-530.

1. 颜新, 千英信, 卫洪昌, 等.下肢深静脉血栓形成的中医治疗进展[J].上海中医杂志, 2006, 37(3):58-60.
2. 陈孝平.外科学[M].北京:人民卫生出版社, 2005:792-794.
3. Harenberg J. Fixed-dose versus adjusted-dose low molecular weight heparin for the initial treatment of patients with deep venous thrombosis[J]. Curr Opin Pulm Med, 2002, 8(5):383-388.
4. Semba CP, Dake MD. Iliofemoral deep venous thrombosis:aggressive therapy with catheter-directed thrombolysis[J]. Radi-ology, 1994, 191(2):467-494.
5. Kearon C, Kahn SR, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)[J]. Chest, 2008, 133(6 Supp1):454S-545S.
6. Watson LI, Armon MP. Thrombolysis for acute deep vein throm-bosis[J]. Cochrane Database Syst Rev, 2004, 18(4):CD00-2783.
7. 刘关键, 吴泰相, 康德英. Meta-分析中统计学过程[J].中国临床康复, 2003, 7(4):538-539.
8. 吴泰相, 刘关键, 赵娜, 等.观察性研究系统评价/Meta-分析的方法[J].中国循证医学杂志, 2004, 4(5):337-341.
9. Higgins JPT, Green S. Cochrane Handbook for SystematicReviews of Interventions Version 5. 0. 1(updated September 2008)[EB/OL]. The Cochrane Collaboration, 2008. Available from www. cochranehandbook. org.
10. Enden T, Kløw NE, Sandvik L, et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis:results of an open randomized, controlled trial reporting on short-term patency[J]. J Thromb Haemost, 2009, 7(8):1268-1275.
11. Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study):a randomised controlled trial[J]. Lancet, 2012, 379(9810):31-38.
12. Elsharawy M, Elzayat E. Early results of thrombolysis versus anti-coagulation in iliofemoral venous thrombosis. A randomized clin-ical trial[J]. Eur J Vase Endovasc Surg, 2002, 24(3):209-214.
13. Mewissen MW, Seabrook GR, Meissner MH, et al. Catheter-dir-ectedthrombolysis for lower extremity deep venous thrombosis:report of a national multicenter registry[J]. Radiology, 1999, 211(1):39-49.
14. Semba CP, Razavi MK, Kee ST, et al. Thrombolysis for lower extremity deep venous thrombosis[J]. Tech Vasc Interv Radiology, 2004, 7(2):68-78.
15. Bjarnason H, Kruse JR, Asinger DA, et al. Iliofemoral deep venous thrombosis:safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy[J]. J Vasc Interv Radiol, 1997, 8(3):405-418.
16. Ly B, Njaastad AM, Sandbaek G, et al. Catheter-directed throm-bolysis of iliofemoral venous thrombosis[J]. Tidsskr Nor Laege-foren, 2004, 124(4):478-480.
17. Sillesen H, Just S, Jørgensen M, et al. Catheter-directed thrombolysis for treatment of iliofemoral deep venous thrombosis is durable, preserves venous valve function and may prevent chroni-cvenous insufficiency[J]. Eur J Vasc Endovasc Surg, 2005, 30(5):556-562.
18. Protack CD, Bakken AM, Pate N, et al. Long-term outcomes of catheter-directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement[J]. J Vasc Surg, 2007, 45(5):992-997.
19. Meissner MH, Wakefield TW, Asher E, et al. Acute venous disease:venous thrombosis and venous trama[J]. J Vasc Surg, 2007, 46 Suppl S:25S-53S.
20. Kearon C. Natural history of venous thromboembolism[J]. Circu-lation, 2003, 107(23 Suppl 1):I22-I30.
21. Janssen MC, Wollersheim H, Schultze-Kool LJ, et al. Local and systemic thrombolytic therapy for acute venous thrombosis[J]. Neth J Med, 2005, 63(3):81-90.
22. Comerota AJ, Schmieder FA. Intraoperative lytic therapy:agents and methods of administration[J]. Simin Vasc Surg, 2001, 14(2):132-142.
23. Segal JB, Streiff MB, Hoffmann LV, et al. Management of ven-ous thromboembolism:a systematic review for a practice guideline[J]. Ann Intern Med, 2007, 146(3):211-222.
24. Ogawa T, Hoshino S, Midorikawa H, et al. Intermittent pneumatic compression of the foot and calf improves the outcome of catheter-directed thrombolysis using low-dose urokinase in pati-ents with acute proximal venous thrombosis of the leg[J].J Vase Surg, 2005, 42(5):940-944.
25. Kakkos SK, Daskalopoulou SS, Daskalopoulos ME, et al. Review on the value of graduated elastic compression stockings after deep vein thrombosis[J].Thromb Haemost, 2006, 96(4):441-445.
26. Vedantham S, Goldhaber SZ, Kahn SR, et al. Rationale and design of the ATTRACT Study:a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis[J]. Am Heart J, 2013, 165(4):523-530.

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The Efficacy and Safety of Conventional Methods Combined with Catheter-Directed Thrombolysis for Acute Deep Vein Thrombosis of Lower Extremity: A Meta-Analysis

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