AB082. SOH24AB_264. Thrombolysis vs. systemic anticoagulation for proximal deep venous thrombosis: a contemporary systematic review and meta-analysis
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AB082. SOH24AB_264. Thrombolysis vs. systemic anticoagulation for proximal deep venous thrombosis: a contemporary systematic review and meta-analysis

Morgan McLoughlin1, Fiona Nolan1, Helen Purtill2, Yasser Abdeldaim1, Zeeshan Ahmed1, Mekki Medani1, Michael Anthony Moloney1, Eamon Gerard Kavanagh1

1Department of Vascular Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland; 2Department of Mathematics & Statistics, University of Limerick, Castletroy, Limerick, Ireland

Background: Systemic anticoagulation with or without locoregional thrombolysis remains the standard of care for deep venous thrombosis (DVT). Questions remain regarding the clinical efficacy of systemic anticoagulation in isolation for proximal DVT.

Methods: A systematic review and meta-analysis was performed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Randomised control trial (RCT) studies comparing thrombolysis plus anticoagulation versus anticoagulation alone from 2000 to 2023 were included. Primary endpoint is post-thrombotic syndrome (PTS) rates. Secondary outcomes included mean Villalta score at final follow up, DVT recurrence, leg ulceration, major bleeding adverse events and mortality.

Results: A total of 206 studies were identified in the search, only 3 RCTs met the inclusion criteria. Data from a total of 987 patients who underwent intervention for a proximal DVT were applicable for meta-analyses [catheter-directed thrombolysis (CDT) n=485, anticoagulation alone n=502]. PTS rate was 33.2% in the intervention group compared to 45.3% in the anticoagulation alone group [odds ratio (OR): 0.60, 95% confidence interval (CI): 0.45–0.80, P=0.0006]. Furthermore, there was a significant difference in mean Villalta score between the groups [mean difference (MD): −1.19, 95% CI: −1.74, −0.64, P<0.0001]. Major bleeding events were 4.5% (thrombolysis group) and 2.6% in (anticoagulation group) (OR: 1.80, 95% CI: 0.90–3.59, P=0.09). Again, no statistically significant differences were seen for recurrent DVT rates (OR: 1.06, 95% CI: 0.72–1.57, P=0.76), leg ulceration (OR: 0.69, 95% CI: 0.35–1.36, P=0.29) or mortality (OR: 0.60, 95% CI: 0.27–1.33, P=0.21).

Conclusions: In contemporary RCTs, the addition of thrombolysis appears superior to anticoagulation alone; however, this result may be limited by heterogeneity in patient selection, participant numbers and length of follow-up.

Keywords: Anticoagulation; deep venous thrombosis (DVT); meta-analysis; thrombolysis; systematic review

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-24-ab082
Cite this abstract as: McLoughlin M, Nolan F, Purtill H, Abdeldaim Y, Ahmed Z, Medani M, Moloney MA, Kavanagh EG. AB082. SOH24AB_264. Thrombolysis vs. systemic anticoagulation for proximal deep venous thrombosis: a contemporary systematic review and meta-analysis. Mesentery Peritoneum 2024;8:AB082.

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