Catheter-Driven Thrombolysis versus Anticoagulation Alone in the Management of Extensive Iliofemoral Deep Vein Thrombosis

Background: Deep vein thrombosis (DVT) occurs when thrombus forms in the deep venous system. This can have life-threatening complications if thrombus embolizes into the pulmonary circulation causing pulmonary embolism. Other complications include postthrombotic syndrome (PTS) and recurrent thrombosis which can affect quality of life in the future. This study aims to compare the difference in short-term and long-term outcomes of treatment of extensive iliofemoral DVT with catheter driven thromolysis (CDT) versus anticoagulation alone.

Materials and Methods: A meta-analysis of 20 randomized control trials was performed. Pros and cons of CDT were compared with anticoagulation alone.

Results: In previous studies, patients treated with CDT were shown to have significantly lower levels of PTS and higher venous patency rates. However, patients who underwent CDT were also shown to have a higher rate of bleeding complications than patients who were treated with anticoagulation alone. The results of the ATTRACT study in 2017 interestingly show that the addition of CDT did not reduce the risk of developing PTS, and in fact, resulted in a greater risk of bleeding.

Conclusion: Over time, evidence has evolved in favor of both strategies. The CaVenT trial demonstrated that 5 years after CDT, patients had a 28% absolute risk reduction in the incidence of PTS; however, there was no difference in the quality of life. CDT may have benefits over anticoagulation alone, as it all allows for complete dissolution of the targeted clot. However, the risk of bleeding is increased in elderly patient populations. Thus it is suggested to use strict eligibility criteria for either means of treatment of iliofemoral DVT or an individualized approach to determine a benefit risk equation in future.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
14 December 2021