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Evidence summaries

Thrombolysis for Acute Deep Vein Thrombosis

Thrombolysis in acute deep vein thrombosis appears to increase complete clot lysis and to slightly reduce the incidence of post-thrombotic syndrome compared to standard anticoagulation. Level of evidence: "B"

The quality of evidence is downgraded by imprecise results (few patients and outcome events).

Summary

A Cochrane review [Abstract] 1 included 19 studies with a total of 1 943 subjects. Studies differed with respect to the thrombolytic agent, the doses of the agent and the techniques used to deliver the agent. Interventions included systemic, locoregional, catheter-directed (CDT) and pharmacomechanical thrombolysis. The majority of studies assessed systemic thrombolysis, with streptokinase the most common agent used.

Complete clot lysis occurred significantly more often in the treatment group (any thrombolysis) in early follow-up (RR 4.75, 95% CI 1.83 to 12.33, statistical heterogeneity I2 =53%; 8 studies, n=592), and at intermediate follow-up (RR 2.42, 95% CI 1.42 to 4.12, statistical heterogeneity I2 =65%; 7 studies, n=654). No differences between strategies (e.g. systemic, loco-regional and CDT) were detected by subgroup analysis. Thrombolysis increased bleeding complications (6.7% versus 2.2%; RR 2.45, 95% CI 1.58 to 3.78; 19 studies, n=1 943). No differences between strategies were detected by subgroup analysis.

Thrombolysis slightly reduced post-thrombotic syndrome (PTS) up to 5 years after treatment (50% vs. 53%) compared to standard anticoagulation (RR 0.78, 95% CI 0.66 to 0.93, statistical heterogeneity I2 =62%; 6 studies, n=1 393), and at late follow-up (beyond 5 years) (RR 0.56, 95% CI 0.43 to 0.73; 2 studies, n=211).

Systemic thrombolysis and catheter-directed thrombolysis (CDT) had similar levels of effectiveness. Studies of CDT included 4 studies in femoral and iliofemoral DVT, and results from these were consistent with those from studies of systemic thrombolysis in DVT at other levels of occlusion.

    References

    • Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database Syst Rev 2021;(1):CD002783. [PubMed]

Primary/Secondary Keywords