Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis

Background

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in the deep vein of the leg or pelvis. It affects approximately 1 in 1000 people. If it is not treated, the clot can travel in the blood, and block the arteries in the lungs. This life-threatening condition is called a pulmonary embolism and occurs in approximately 3 to 4 in 10,000 people. Another side-effect of DVT is post-thrombotic syndrome (PTS), a condition in which the patient suffers pain, swelling, and changes in the skin of the leg, which can lead to an ulcer. This causes significant disability and diminished qualify of life, and is costly to the healthcare system.

One way to prevent another blood clot or PTS is to remove the clot. There are a number of ways to do this. A catheter can be inserted into the vein and the clot removed directly (mechanical thrombectomy), the clot can be broken down through the use of drugs infused into a vein in the foot or directly at the site of the clot using a catheter and X-ray control (pharmacomechanical thrombolysis), or a combination of the two procedures. This review aimed to measure how safe and effective pharmacomechanical thrombectomy is, compared to other techniques.

Key results

There were no randomised controlled trials that met the inclusion criteria of this review (current until December 2015). We identified one ongoing study.

Quality of evidence

At present, there is a lack of randomised controlled trials that examine the comparative effectiveness and safety of pharmacomechanical thrombectomy in the management of patients with DVT.

Conclusion

Further research is required before conclusions can be made.

Authors' conclusions: 

There were no randomised controlled trials that assessed the effects of pharmacomechanical thrombectomy versus anticoagulation (alone or with compression stockings), mechanical thrombectomy, thrombolysis, or other endovascular techniques in the management of people with acute DVT of the iliofemoral vein that met the eligibility criteria for this review. Further high quality randomised controlled trials are needed.

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Background: 

Deep venous thrombosis (DVT) occurs in approximately one in 1000 adults every year, and has an annual mortality of 14.6%. In particular, iliofemoral DVT can lead to recurrent thrombosis and post-thrombotic syndrome (PTS), a painful condition which can lead to chronic venous insufficiency, oedema, and ulceration. It causes significant disability, impaired quality of life, and economic burden. Early thrombus removal techniques have been advocated in patients with an iliofemoral DVT in order to improve vein patency, prevent valvular dysfunction, and reduce future complications, such as post-thrombotic syndrome and venous ulceration. One such technique is pharmacomechanical thrombectomy, a combination of catheter-based thrombectomy and catheter-directed thrombolysis.

Objectives: 

To assess the effects of pharmacomechanical thrombectomy versus anticoagulation (alone or with compression stockings), mechanical thrombectomy, thrombolysis, or other endovascular techniques in the management of people with acute DVT of the iliofemoral vein.

Search strategy: 

The Cochrane Vascular Information Specialist searched the Specialised Register (last searched December 2015) and the Cochrane Register of Studies (last searched December 2015). We searched clinical trials databases for details of ongoing or unpublished studies and the reference lists of relevant articles retrieved by electronic searches for additional citations.

Selection criteria: 

Randomised controlled trials in which patients with an iliofemoral deep vein thrombosis were allocated to receive pharmacomechanical thrombectomy versus anticoagulation, mechanical thrombectomy, thrombolysis (systemic or catheter directed thrombolysis), or other endovascular techniques for the treatment of iliofemoral DVT.

Data collection and analysis: 

At least two review authors independently assessed studies identified for potential inclusion.

Main results: 

We found no randomised controlled trials that met the eligibility criteria for this review. We identified one ongoing study.

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